Abstract Number: PB0113
Meeting: ISTH 2020 Congress
Background: Arterial thromboembolism of the infrarenal abdominal aorta results from aortoiliac occlusive disease or Leriche syndrome. Pulmonary embolism is usually caused by an embolic thrombus originating from a deep vein thrombosis. The underlying causes of both vascular thromboembolic diseases are multifactorial and a link between venous and arterial thrombotic disorders is still unclear.
Aims: We present a case of a 55-year-old woman suffering from Leriche syndrome after consecutive multiple pulmonary embolisms of idiopathic origin.
Methods: A 55-year-old woman presented herself in the emergency department with acute onset of dyspnea and pain in the left leg for 4 days. A formerly intake of oral anticoagulation therapy due to idiopathic pulmonary embolism was stopped already over a year before. Computed tomography revealed central pulmonary embolism with right ventricular overload. Initial treatment with heparin was initiated, the patient stabilized noticeably. Another 5 days later, the patient developed sudden onset paresthesia, paraplegia and pulselessness of both lower limbs revealing Leriche syndrome. During consecutive arterial embolectomy, the patient again became hemodynamically instable suggesting a further progression of the pulmonary embolism.
Results: Atrial fibrillation as well as a patent foramen ovale was excluded as cause for arterial embolism. Interim suspected heparin-induced thrombocytopenia was also not confirmed. Despite adipositas, no other risk factors for venous thromboembolism were known and standardized screening for thrombophilia, in particular antiphospholipid syndrome, was negative. Evaluation of JAK2 V617F, JAK 2 exon-12 and calreticulin exon-9 mutation was unremarkable. At discharge, anticoagulation therapy with phenprocoumon was initiated. No further thromboembolic events occurred within 1 year follow up.
Conclusions: Leriche syndrome and pulmonary embolism are two thromboembolic and potential life-threatening diseases with multifactorial origins. In this case no underlying cause for the thromboembolic events could be found and a link between arterial and venous thrombotic disorders remains uncertain.
To cite this abstract in AMA style:Muster V, Jud P, Gütl K, Tomka M, Baumann A, Anelli-Monti M, Srekl-Filzmaier P, Portugaller RH, Brodmann M, Gary T. Acute Leriche Syndrome in a 55-Year-Old Woman with Recurrent Central Pulmonary Embolism: A Case Report [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/acute-leriche-syndrome-in-a-55-year-old-woman-with-recurrent-central-pulmonary-embolism-a-case-report/. Accessed January 26, 2022.
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