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Hypercoagulable Conditions Leading to Limb Ischemia

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Critical Limb Ischemia

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Abstract

Acute arterial occlusion with associated critical limb ischemia commonly arises from either thromboembolism or plaque rupture with in situ thrombosis. Other less frequent mechanisms include arterial dissection, transection, surgical ligation, arteritis, tumor in situ, invasion or embolization, foreign body embolization, and vasospasm (sepsis, vasopressor use, shock). “Thrombophilia” is a term coined to describe conditions of increased propensity for thrombus formation particularly involving the venous circulation. In the evaluation of patients with acute arterial occlusion, there are several important entities to consider in the thrombophilia assessment. These include antiphospholipid antibody syndrome, heparin-induced thrombocytopenia, and myeloproliferative neoplasms. Paradoxic emboli arising from venous thromboembolism gaining access to the arterial circulation via patent foramen ovale, atrial, or ventricular septal defects are an uncommon but a well-defined entity to consider. For these patients, the typical venous thrombophilia risk factors are relevant participants. Lastly, undiagnosed paroxysmal atrial fibrillation is an entity worth searching for and may explain up to 20 % of cryptogenic stroke and possible peripheral embolic events. This chapter will provide clinical clues in the search for underlying thrombotic propensities relevant for acute arterial occlusion.

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Authors and Affiliations

  1. Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA

    Arjun Jayaraj MBBS, MPH, RPVI

  2. Department of Cardiovascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, 55905, USA

    Waldemar E. Wysokinski MD, PhD & Robert D. McBane MD

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  1. Arjun Jayaraj MBBS, MPH, RPVI
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  2. Waldemar E. Wysokinski MD, PhD
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  3. Robert D. McBane MD
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Editors and Affiliations

  1. Loyola University Medical Center, Maywood, Illinois, USA

    Robert S. Dieter

  2. Northwestern Medicine Central DuPage Hospital, Glen Ellyn, Illinois, USA

    Raymond A. Dieter, Jr

  3. The University of Tennessee Medical Center, Knoxville, Tennessee, USA

    Raymond A. Dieter, III

  4. West Virginia University, Charleston, West Virginia, USA

    Aravinda Nanjundappa

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Jayaraj, A., Wysokinski, W.E., McBane, R.D. (2017). Hypercoagulable Conditions Leading to Limb Ischemia. In: Dieter, R., Dieter, Jr, R., Dieter, III, R., Nanjundappa, A. (eds) Critical Limb Ischemia. Springer, Cham. https://doi.org/10.1007/978-3-319-31991-9_25

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