Recurrent Acute Limb Ischaemia due to Malignant Thromboembolism Involving Bilateral Lower Limbs Simultaneously

Acute Limb Ischaemia (ALI) is a limb and life-threatening condition that is often associated with cardiovascular disease, atrial fibrillation (AF), diabetes and smoking. It is less commonly associated with active malignancy. There is growing evidence regarding this association. This case report details the case of a patient with active malignancy who had two separate episodes of ALI secondary to tumour thromboembolism, including both his lower limbs simultaneously.

A 68-year-old Caucasian male with a known history of Squamous Cell Lung Cancer on immunotherapy presented with ALI of his left upper limb that was managed surgically with a brachial embolectomy. Despite ongoing therapeutic anticoagulation, he presented again with ALI, this time involving both his lower limbs. This was treated successfully surgically, and the patient was discharged home after a prolonged period of rehabilitation. During this inpatient stay, he was found to have new cerebral metastases.

This case highlights that oncological patients can have ALI that is not due to atherosclerotic disease alone and can still occur while patients are therapeutically anticoagulated. Furthermore, this case underscores the need for early involvement of oncology given that such presentations may indicate disease progression and indicate a poorer prognosis for many of such patients.