Manual High-Dose Regional Intraoperative Thrombolysis of Lower Extremity Emboli After Open Repair of a Ruptured Abdominal Aortic Aneurysm

A rare coexistence of acute thrombotic occlusion of the left popliteal-tibioperoneal artery and the left iliofemoral vein: a case report

“…Similar to this case report, Herity et al reported a 61-year-old man with arterial and venous thrombus in the left lower extremity in 1997 [ 5 ]. Acute arterial thromboembolism can be treated by surgical thromboembolectomy or CDT thrombolytic therapy, whereas in acute proximal DVT, CDT thrombolysis and/or PMT modalities are effective treatment methods that reduce morbidity [ 13 , 16 ]. In our current smoker patient who was learned to have been operated for AAA, we successfully performed surgical thromboembolectomy for the treatment of left popliteal-tibioperoneal artery thromboembolism and PMT + CDT for the treatment of acute left iliofemoral venous thrombosis.…”

“…Smoking causes an increase in plasma catecholamine release, sympathetic nerve stimulation, arterial stiffness, chronic low-grade inflammation, endothelial dysfunction, blood pressure changes and hypertension, and these mechanisms that accelerate atherosclerosis lead to plaque rupture and acute arterial occlusion [ 12 ]. Lower extremity acute ischemia secondary to distal arterial embolization, which is reported to develop rarely after abdominal aortic surgery, is a serious complication that can cause reoperation and even amputations [ 13 , 14 ]. Thromboembolectomy is an effective treatment option in the proximal segment thromboembolism of the lower extremity, and it is known that CDT is more effective and safe than systemic thrombolysis especially in distal thromboembolism [ 13 – 15 ].…”

“…Lower extremity acute ischemia secondary to distal arterial embolization, which is reported to develop rarely after abdominal aortic surgery, is a serious complication that can cause reoperation and even amputations [ 13 , 14 ]. Thromboembolectomy is an effective treatment option in the proximal segment thromboembolism of the lower extremity, and it is known that CDT is more effective and safe than systemic thrombolysis especially in distal thromboembolism [ 13 – 15 ]. Although there are many case reports and studies in the literature regarding arterial and venous thrombosis, the coexistence of them in the same extremity is a rare clinical finding.…”