Antiphospholipid syndrome: patterns of life-threatening and severe recurrent vascular complications

To demonstrate the variety and recurrence patterns of severe arterial and venous thromboembolic events that occur in patients with the antiphospholipid syndrome.

Radiology records were reviewed in 800 of 1,633 patients with positive test results of antiphospholipid syndrome. Patients with radiologic evidence of antiphospholipid syndrome and no other hypercoagulable state were included if the observed thromboembolic event met one or more of four criteria for severity: extreme complications or mortality, three or more recurrent events, unusually young age, and/or unusual sites affected.

In the 24 patients who met the selection criteria, 72 thromboembolic episodes and 56 (78%) recurrences were found. Arterial complications included aortic occlusions, visceral infarctions, upper- and lower-extremity arterial thrombosis, strokes, and repeated graft occlusions. Venous complications included portal vein thrombosis, transverse and sagittal sinus thrombosis, upper- and lower-extremity thrombosis, and recurrent pulmonary emboli.

Vascular complications of antiphospholipid syndrome include serious and life-threatening events. Primary thromboembolic episodes often recur at the same site or within the same system (arterial vs venous system). These events can also trigger a rapid succession of critical thrombotic episodes at multiple sites.