Author + information
- Received February 5, 2018
- Revision received February 15, 2018
- Accepted February 20, 2018
- Published online August 20, 2018.
- Shoko Nakagawa, MDa,
- Osami Kawarada, MD, PhDa,∗ (, )
- Takeshi Yagyu, MDa,
- Jiro Matsuo, MDb,
- Yosuke Inoue, MDb,
- Teruo Noguchi, MD, PhDa and
- Satoshi Yasuda, MD, PhDa
- aDepartment of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
- bDepartment of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
- ↵∗Address for correspondence:
Dr. Osami Kawarada, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.
The relationship between peripheral artery disease and myeloproliferative disorder might have been underappreciated despite its clinical significance (1–3).
An 87-year-old woman was referred to our institution because of sudden onset of right lower leg pain. She did not have right popliteal and pedal pulses. Enhanced computed tomography revealed an extensive occlusion in the right infrapopliteal artery (Figure 1A). Laboratory testing showed peripheral leukocytosis (68,300/μl), with 70% blast cells. We made a diagnosis of acute limb ischemia associated with acute leukemia. Following surgical Fogarty thrombectomy, we successfully removed a thrombus of considerable size (Figure 1B). Pathological examination of the removed thrombus demonstrated numerous white blood cells similar to blast cells, with positive myeloperoxidase staining (Figures 1C and 1D). Subsequent bone marrow aspiration demonstrated acute myeloblastic leukemia. She passed away 2 weeks later because of acute myeloblastic leukemia.
An 87-year-old woman with a history of rheumatoid arthritis receiving steroid therapy was referred to our institution for the treatment of non-healing right toe gangrene. She had undergone left below-the-knee amputation 3 years ago and had untreated thrombocytosis. Physical examination on admission showed a right dorsalis pulse. Skin perfusion pressure of the dorsal and plantar foot was 40 to 50 mm Hg, suggesting that wound healing was likely. Angiography revealed abrupt occlusions of the dorsalis pedis and plantar arteries with a type 3A infrapopliteal artery variant (4) (Figure 2). Laboratory testing showed thrombocytosis (900,000/μl). There was no evidence of embolic sources based on echocardiography and vascular ultrasonography. Following a hematology consultation, we made a diagnosis of foot artery occlusion associated with essential thrombocytosis. Medical management including a platelet-lowering agent (anagrelide) and wound care facilitated toe autoamputation.
The present images suggest the need for increased awareness of the potential for myeloproliferative disorders in patients with acute or chronic limb ischemia.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 5, 2018.
- Revision received February 15, 2018.
- Accepted February 20, 2018.
- 2018 American College of Cardiology Foundation