Protein C and/or S deficiency presenting as peripheral arterial insufficiency
| Autor: | Sang-Gu Lee, M S Han, Kang Gh, Yeul Hong Kim, Ahn Jh, Kwak Jh, Young-Uk Cho, Kwon Tw |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
Adult
Male medicine.medical_specialty Protein S Deficiency medicine.medical_treatment Iliac Artery Risk Factors Protein C deficiency medicine.artery Coagulopathy Humans Medicine Radiology Nuclear Medicine and imaging Prospective Studies Risk factor Prospective cohort study Aged Peripheral Vascular Diseases Aorta business.industry Anticoagulants Protein C Deficiency Thrombosis General Medicine Thrombolysis Middle Aged medicine.disease Surgery Femoral Artery Radiography Treatment Outcome medicine.anatomical_structure Female business Protein C medicine.drug Artery |
| Zdroj: | The British Journal of Radiology. 78:601-605 |
| ISSN: | 1748-880X 0007-1285 |
| Popis: | Although protein C and/or S deficiency has frequently been associated with venous thromboembolic events, instances of arterial thromboses have been reported. However, the exact incidence of protein C and/or S deficiency in patients with peripheral arterial insufficiency has not been established. Furthermore, given the lack of adequate studies to define the natural history and angiographic findings of these patients, the treatment has not been well delineated. Therefore, we conducted a prospective study to investigate the prevalence, characteristic angiographic findings and optimal treatments in patients with peripheral arterial insufficiency associated with protein C and/or S deficiency. Between September 2000 and August 2004, 133 patients who presented with peripheral arterial insufficiency underwent hypercoagulability tests before the initiation of any treatments. Of these, 11 patients (8.3%) with protein C and/or S deficiency were included in this study. There were nine males and two females. The ages ranged from 38 years to 72 years (mean 57 years). All patients showed characteristic angiographic findings: long segment thrombotic occlusion of a main peripheral artery without evidence of atherosclerosis or with mild atherosclerotic changes in the aorta and other major arterial trees. Surgical or endovascular procedures were performed in nine patients: bypass graft in four, thrombectomy in four and catheter-directed thrombolysis in one. Conservative treatment with full anticoagulation was performed in two patients. All patients received pre- and post-operative anticoagulation. Except for one amputated case, clinical and vascular laboratory improvements were achieved in 10 patients. Mean follow-up period was 21 months (range 4-45 months). However, one patient, in whom re-vascularization surgery was performed successfully, discontinued warfarin therapy himself at 10 months after surgery, graft occlusion and limb loss occurred at 30 months after surgery. This initial experience suggests that protein C and/or S deficiency may be an independent risk factor for peripheral arterial insufficiency. Patients who present with peripheral arterial insufficiency and protein C and/or S deficiency demonstrate characteristic angiographic findings. Once the diagnosis of protein C and/or S deficiency is made, patients should be treated with life-long anticoagulation. |
| Databáze: | OpenAIRE |
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