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[A young patient with multiple arterial occlusions]
C Panzere1, A Brieke, B Bräuer
1Medizinische Abteilung für Endokrinologie, Stoffwechsel Und Angiologie, Städtisches Krankenhaus München-neuperlach.
Insights
Mild hyperhomocysteinemia is a significant risk factor for premature arterial occlusive disease. This case highlights its role in a young female with multiple arterial occlusions, emphasizing the need for considering this condition in diagnosis.
Area of Science:
- Vascular Medicine
- Cardiovascular Disease
- Metabolic Disorders
Background:
- Mild hyperhomocysteinemia, stemming from genetic or nutritional factors, is a recognized independent risk factor for premature arterial occlusive disease.
- Arterial occlusive disease can manifest in various vascular beds, impacting organs such as the intestines and extremities.
Observation:
- A 27-year-old female presented with symptoms of acute limb ischemia and a history of recurrent small bowel ileus.
- Angiography identified occlusions in the popliteal artery, superior mesenteric artery, and celiac trunk.
- Patient risk factors included smoking, oral contraceptive use, and elevated homocysteine levels.
Findings:
- Conservative treatment with prostaglandins and physical therapy was initiated.
- Oral supplementation with folate and B vitamins normalized homocysteine levels after 4 weeks.
- No genetic defect in homocysteine metabolism enzymes was identified.
Implications:
- This case underscores the importance of considering mild hyperhomocysteinemia in the differential diagnosis of premature arterial occlusive disease, even in young patients.
- Effective management of hyperhomocysteinemia through vitamin supplementation can potentially mitigate vascular risks.
- Further investigation into non-genetic causes of hyperhomocysteinemia is warranted in such cases.
Background:
Mild hyperhomocysteinemia due to genetic causes and nutrition factors is well known as an independent strong risk factor for premature arterial occlusive disease.
Case Report:
A 27-year-old female with a history of two episodes of small bowel ileus due to vascular causes presented with subacute pain in the left lower extremity. Angiography revealed a short segmental occlusion in the P III segment of the popliteal artery with small vessel collateralization and proximal occlusion of the superior mesenteric artery und the coeliac trunk. Vascular risk factors in this patient included smoking over a duration of 10 years, use of oral contraceptives (estrogen and gestagen combination) and elevated levels of homocysteine in the fasting state and after methionin loading. The patient was treated conservatively with intravenous application of prostaglandins, additionally she underwent training to improve her walking capability. After 4 weeks of the fasting state as well as after methionin loading were normalized by an oral substitution with folate and B vitamins. So far it was not possible to prove a genetic defect of the enzymes participating in the metabolism of homocysteine.
Conclusion:
This clinical conference of a young female patient with occlusion of several arteries illustrates the differential diagnosis of premature occlusive vascular disease with special regard to mild hyperhomocysteinemia as an independent risk factor.