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HIV and Arterial Thromboembolism as Cause of Acute Limb Ischemia: 2 Case Reports
Simpledeep Banipal, MD, Carl Valentin, MD, Daniel Katz, MD, Samantha Minc, MD.
Mount Sinai Hospital, Chicago, IL, USA.
OBJECTIVES:
Human immunodeficiency virus (HIV) infection has been linked to a hypercoagulable state. Despite this, there have been few case reports about arterial thromboembolism in HIV patients with no other predisposing factors. We present two case reports of young females with a history of HIV found to have arterial thromboembolism as the cause of acute limb ischemia.
METHODS:
Two case reports and brief review of the literature.
RESULTS:
Patient A is a 41-year-old female with a recent diagnosis of HIV presenting with acute onset right lower extremity pain for 2 weeks and CTA findings of thrombus in the popliteal artery, anterior tibial artery and tibial-peroneal trunk. The patient was treated with catheter directed thrombolysis for 3 days, resolving the thrombus in the popliteal artery. Patient B is a 39-year-old female with a longstanding history of HIV and a distant history of embolic stroke with left hemiparesis, presenting with a 3-day history of right lower extremity pain. The patient was found to have near occlusive thrombus in the aorta with a short segment of left common iliac artery thrombus and occlusion of the right iliac and common femoral artery. The patient had reconstitution of the right superficial and profunda femoral artery but went on to occlude distal to the popliteal artery (figure 1a). The patient was treated with bilateral iliofemoral and aortic thrombectomy (figure 1b). The cardiac echo failed to show a cardiac origin of embolism in either patient. The patients were treated with long-term anticoagulation with warfarin.
CONCLUSIONS:
This case study documents the management of two young HIV positive females presenting with limb ischemia as the result of non-cardiac thromboembolic events. We used both operative and pharmacologic therapies to address this issue. HIV has been linked to hypercoagulable events,with venous thromboembolism (VTE) being studied more than arterial thromboembolism.It has also been noted that patients with HIV and VTE might not respond to anti-coagulation with warfarin or enoxaparin.More studies are needed to address arterial thromboembolism in HIV infected patients along with long-term anticoagulation treatment options.
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