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The Association Between Acute Limb Ischemia And Cocaine Use
Roy Chen, Mackenzie Jackson, Bara Zuhaili.
Michigan Health-Sparrow General Surgery, Lansing, MI, USA.
OBJECTIVES: Arterial thrombosis secondary to cocaine use is a poorly documented pathology. A comprehensive literature review demonstrated a scarcity of published information regarding this topic with several single-patient case reports and one case series (5 patients). This study was performed to better elucidate the natural history of cocaine-associated acute limb ischemia.
METHODS:We began by performing a retrospective review dating back to January 2022. ICD 9 and ICD 10 codes were used to identify patients with both acute limb ischemia and active cocaine use. Data was collected regarding demographics, medical comorbidities, additional substance use, PAD history, presentation of their acute ischemic process, and ultimate outcomes
RESULTS:17 patient encounters were identified based on ICD code. 9 patients were excluded on chart review due to a lack of true acute limb ischemia. Ultimately 7 patients with 8 encounters were identified and evaluated.
The average onset of symptoms before evaluation was 51 hours. An average of 25 hours between cocaine use and onset of symptoms was reported. 7 encounters (87.5%) had paresthesias at time of evaluation, 5 (62.5%) had some motor impairment with 1 (12.5%) presenting with paralysis. 5 occlusive events were identified in the left lower extremity (62.5%), 1 in the right lower extremity (12.5%), and 1 in the left upper extremity (12.5%). In the lower extremity, 4 events were aortoiliac (50%), 3 were femoral (37.5%). 2 patients underwent thrombolysis (25%), 5 underwent thrombectomy (62.5%), 1 underwent index amputation (12.5%). 1 thrombectomy patient required amputation during the index hospital stay. 4 encounters required amputation within 30 days, 2 of whom had in-hospital mortality.
CONCLUSIONS: Our patient population demonstrated significantly worse rates of limb salvage compared to the other published data. Of the 8 operations, only 1 patient was patent at 1 year without operation (12.5%) and only 1 other successfully had limb salvage however required lower extremity bypass (12.5%). The etiology of this could be the delayed presentation of this patient population. Additional research is being performed by our group to collect 10-year data to better identify statistically significant patterns and then to compare this group to patients with acute limb ischemia without concomitant cocaine use.
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