Arterial reconstruction in patients with polycythemia vera

The natural history of polycythemia vera (PV) with its inherent arterial and venous complications are well described but the results of arterial surgical treatment in patients with PV are not known. This study was done to determine the outcome of arterial surgical treatment in patients with PV. During the last six and one-half years, of 2,603 extensive vascular procedures performed, seven reconstructions were performed upon six patients with PV. Extensive complications occurred in 57 per cent of this group. All of the complications occurred in patients with disease of the lower extremity and resulted in extensive amputation in one-half of the patients. The average preoperative platelet count was higher (420,000) in patients with complications as compared with those who did well (303,000). All of the patients requiring chemotherapeutic control of the PV (hydroxyurea) had extensive complications. These results indicate that vascular operations in patients with PV carry a high complication rate. A platelet count of more than 330,000, more than 70 years of age, infrainguinal reconstruction and PV requiring hydroxyurea for control seem predictive of a poor outcome. Although this series is small, we believe that great caution should be exercised before attempting vascular reconstructions in patients with PV and the aforementioned risk factors.