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Cocaine Induced Arterial Thrombosis of the Lower Extremity
Gregory A. Stanley, MD, Allen Lee, MD, Richard C. Hershberger, MD, Stephen T. Smith, MD, Carlos H. Timaran, MD, J. Gregory Modrall, MD, Frank R. Arko, III, MD, R. James Valentine, MD, G. Patrick Clagett, MD.
UT Southwestern, Dallas, TX, USA.

Objective: Recreational cocaine use has been credibly linked to many health hazards, including acute coronary syndrome, cardiac arrhythmia, hypertensive crisis, stroke, intestinal ischemia, and sudden death. Several reports have documented presumed cocaine-induced arterial thrombosis of the coronary or cerebral vasculature, but rarely has this phenomenon been established in the periphery. This study aims to review our experience with cocaine-induced peripheral arterial thrombosis requiring operative thrombectomy.
Methods: A retrospective chart review was performed of patients undergoing emergency lower extremity thrombectomy from August 1995 to January 2011. Patients treated for arterial trauma, acute thrombosis of revascularization grafts, acute thrombosis of chronic peripheral arterial disease, or by thrombolytic therapy were excluded from this study. Records were reviewed to obtain patient demographics, co-morbidities, risk factors for atherosclerotic disease, results of urine toxicology screen, operative details, hospital course, and peri-operative outcomes.
Results: Over the 15-year study period, 123 patients underwent emergency surgical thrombectomy at our institution. Eleven patients (8.9%) had cocaine-positive urine toxicology screens, confirming cocaine use within 72 hours of presentation. In comparison to non-cocaine users, cocaine-positive patients were significantly younger (43.0±9.9 vs. 57.5±13.5 years, P<.001) and were less likely to have more than one risk factor for atherosclerotic vascular disease (45.4% vs. 74.1%, P=.07). Thrombus was removed from cocaine-negative patients at the aortoiliac (n=57, 51%), femoropopliteal (n=65, 58%), and tibioperoneal (n=14, 12%) region, whereas all cocaine-positive patients required femoropopliteal thrombectomy (n=11, P=.002). Major (above-knee or below-knee) amputation rate was not significantly differently among cocaine users (n=2, 18.2%) and presumed non-cocaine users (n=30, 26.8%). Outcome measures including perioperative myocardial infarction, stroke, death, and hospital length of stay were not significantly different between the groups. Mean follow-up was 7.8 years (range, 0.8 - 16.1 years).
Conclusion: This study further substantiates the association between cocaine use and acute peripheral arterial thrombosis, and specifically localizes clot formation at the femoropopliteal level. Clinical suspicion for cocaine induced acute arterial thrombosis should remain high in young patients presenting with lower extremity ischemia to expedite an appropriate treatment strategy. Surgical thrombectomy continues to be a suitable option for intervention in these patients.


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