Accepted Manuscript Hybrid treatment of lower limb critical ischemia in a patient with systemic lupus erythematosus Sotirios Giannakakis, George Galyfos, Ioannis Stefanidis, Georgios Kastrisios, Chrisostomos Maltezos PII:
S0890-5096(15)00027-8
DOI:
10.1016/j.avsg.2014.10.040
Reference:
AVSG 2235
To appear in:
Annals of Vascular Surgery
Received Date: 10 September 2014 Revised Date:
21 October 2014
Accepted Date: 23 October 2014
Please cite this article as: Giannakakis S, Galyfos G, Stefanidis I, Kastrisios G, Maltezos C, Hybrid treatment of lower limb critical ischemia in a patient with systemic lupus erythematosus, Annals of Vascular Surgery (2015), doi: 10.1016/j.avsg.2014.10.040. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Hybrid treatment of lower limb critical ischemia in a patient with systemic lupus erythematosus
Sotirios Giannakakis; George Galyfos; Ioannis Stefanidis; Georgios Kastrisios;
RI PT
Chrisostomos Maltezos.
SC
Department of Vascular Surgery, ‘KAT’ General Hospital of Athens, Athens, Greece.
Corresponding Author: George Galyfos, 6 Melinas Merkouri Street, Neon Iraklion,
Fax.: +30-210-7707574
TE D
Tel.: +30-213-2086343
M AN U
14122, Athens, Greece. ([email protected])
AC C
EP
Type of the article: Case report
ACCEPTED MANUSCRIPT Abstract
Systemic lupus erythematosus (SLE) is a chronic inflammatory multi-systemic disease, which affects primarily small-sized vessels, arterioles, venules and capillaries
RI PT
in the cardiovascular system. Less often, medium-sized vessels are affected, and large-sized vessels are affected rarely. We report an unusual case of a 52-year-old female patient with SLE under treatment and multi-leveled arterial obstructive disease of the lower limb, who presented with critical limb ischemia. The patient was treated
SC
using a hybrid endovascular and open revascularization procedure, based on the clinical picture of the patient, the angiographic findings and the experience of our department. Our aim is not only to highlight the rarity of the clinical picture but also
M AN U
to make useful conclusions regarding the proper management for such unusual cases. Given the fact that there are no guidelines, we present the treatment strategy selected
TE D
for our patient and discuss our results.
AC C
EP
Keywords: critical limb ischemia; systemic lupus erythematosus; hybrid treatment.
ACCEPTED MANUSCRIPT Introduction
Thrombosis in blood vessels of different sizes is a major complication in systemic lupus erythematosus SLE [1,2]. Although the vasculitis could be the background for
RI PT
the thrombosis, there are strong indications that antiphospholipid antibodies (APLs: anticardiolipin antibodies [aCL]; lupus anticoagulant [LA]) are associated with blood coagulation without the presence of inflammation [3,4]. Clinical manifestations include thrombocytopenia, recurrent vein or arterial thrombosis, recurrent embryon
SC
abortion and heart valvular disease [3]. In anti-phospholipid syndrome, arterial thrombosis occurs mainly in the brain, although peripheral arteries are affected less
M AN U
frequently [4].
Regarding management of patients with SLE and critical limb ischemia, there are no specific guidelines, and only isolated cases have been reported [4]. We present an unusual case of such a patient with critical lower limb ischemia and multiple stenotic arterial lesions, who underwent a hybrid interventional management. We discuss
AC C
EP
TE D
proper treatment for such cases as well.
ACCEPTED MANUSCRIPT Case report
A 52-year old female patient suffering from SLE for 30 years presented in the emergency department due to right lower limb rest pain during the last 4 days, paresis
RI PT
and paraesthesias of the right foot as well as ischemic lesions of the ipsilateral first toe. Her medical treatment included coumarin anticoagulants, as a long-term prophylaxis after a deep vein thrombosis ten years ago (goal: 2.5
S0890-5096(15)00027-8
DOI:
10.1016/j.avsg.2014.10.040
Reference:
AVSG 2235
To appear in:
Annals of Vascular Surgery
Received Date: 10 September 2014 Revised Date:
21 October 2014
Accepted Date: 23 October 2014
Please cite this article as: Giannakakis S, Galyfos G, Stefanidis I, Kastrisios G, Maltezos C, Hybrid treatment of lower limb critical ischemia in a patient with systemic lupus erythematosus, Annals of Vascular Surgery (2015), doi: 10.1016/j.avsg.2014.10.040. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Hybrid treatment of lower limb critical ischemia in a patient with systemic lupus erythematosus
Sotirios Giannakakis; George Galyfos; Ioannis Stefanidis; Georgios Kastrisios;
RI PT
Chrisostomos Maltezos.
SC
Department of Vascular Surgery, ‘KAT’ General Hospital of Athens, Athens, Greece.
Corresponding Author: George Galyfos, 6 Melinas Merkouri Street, Neon Iraklion,
Fax.: +30-210-7707574
TE D
Tel.: +30-213-2086343
M AN U
14122, Athens, Greece. ([email protected])
AC C
EP
Type of the article: Case report
ACCEPTED MANUSCRIPT Abstract
Systemic lupus erythematosus (SLE) is a chronic inflammatory multi-systemic disease, which affects primarily small-sized vessels, arterioles, venules and capillaries
RI PT
in the cardiovascular system. Less often, medium-sized vessels are affected, and large-sized vessels are affected rarely. We report an unusual case of a 52-year-old female patient with SLE under treatment and multi-leveled arterial obstructive disease of the lower limb, who presented with critical limb ischemia. The patient was treated
SC
using a hybrid endovascular and open revascularization procedure, based on the clinical picture of the patient, the angiographic findings and the experience of our department. Our aim is not only to highlight the rarity of the clinical picture but also
M AN U
to make useful conclusions regarding the proper management for such unusual cases. Given the fact that there are no guidelines, we present the treatment strategy selected
TE D
for our patient and discuss our results.
AC C
EP
Keywords: critical limb ischemia; systemic lupus erythematosus; hybrid treatment.
ACCEPTED MANUSCRIPT Introduction
Thrombosis in blood vessels of different sizes is a major complication in systemic lupus erythematosus SLE [1,2]. Although the vasculitis could be the background for
RI PT
the thrombosis, there are strong indications that antiphospholipid antibodies (APLs: anticardiolipin antibodies [aCL]; lupus anticoagulant [LA]) are associated with blood coagulation without the presence of inflammation [3,4]. Clinical manifestations include thrombocytopenia, recurrent vein or arterial thrombosis, recurrent embryon
SC
abortion and heart valvular disease [3]. In anti-phospholipid syndrome, arterial thrombosis occurs mainly in the brain, although peripheral arteries are affected less
M AN U
frequently [4].
Regarding management of patients with SLE and critical limb ischemia, there are no specific guidelines, and only isolated cases have been reported [4]. We present an unusual case of such a patient with critical lower limb ischemia and multiple stenotic arterial lesions, who underwent a hybrid interventional management. We discuss
AC C
EP
TE D
proper treatment for such cases as well.
ACCEPTED MANUSCRIPT Case report
A 52-year old female patient suffering from SLE for 30 years presented in the emergency department due to right lower limb rest pain during the last 4 days, paresis
RI PT
and paraesthesias of the right foot as well as ischemic lesions of the ipsilateral first toe. Her medical treatment included coumarin anticoagulants, as a long-term prophylaxis after a deep vein thrombosis ten years ago (goal: 2.5
