Cardiovascular Journal of Africa: Vol 24 No 2 (March 2013)

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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 2, March 2013 AFRICA e7
Case Report
Acute arterial thrombosis following chemotherapy in a
patient with a gastric carcinoma
SUAT DOGANCI, MURAT KADAN, ERKAN KAYA, GOKHAN EROL, CELALETTIN GUNAY, UFUK DEMIRKILIC
Abstract
The pathogenesis of in situ thrombosis in cancer patients is
not well known. Possible factors include endothelial damage,
decreasing levels of anticoagulant factors and increasing
levels of pro-coagulants. In the literature, the incidence
of arterial thrombosis in cancer patients is reported to be
3.8%; 5-fluorouracil is mentioned as a rare causative agent,
whereas cisplatin is thought to be the most common agent
responsible for in situ thrombosis. In this report we present
a 43-year-old male patient with bilateral popliteal artery
embolism after 5-fluorouracil/cisplatin/taxotare combination
chemotheraphy for gastric carcinoma. He had no additional
risk factors such as smoking or any persistent organic arte-
rial disease. He had sinus cardiac rhythm on electrocardiog-
raphy and there were no abnormalities on echocardiography
that could have been source of emboli. Surgical thrombec-
tomy was performed with effective anticoagulation. After the
operation, our medical oncologist discontinued 5-fluoroura-
cil. At follow up, there was no evidence of thrombosis, with
normal vascular flow rate.
Keywords: acute arterial ischaemia, malignancy, chemotherapy,
surgical intervention
Submitted 25/7/12, accepted 22/10/12
Cardiovasc J Afr 2013; 24: e7–e9
DOI: 10.5830/CVJA-2012-074
Thrombotic episodes are one of the most common causes of
morbidity and mortality in patients with malignancies, with or
without concomitant chemotherapy. The exact pathogenesis of
thrombosis is poorly understood and most likely multifactorial.1
Chemotherapy is a recognised risk factor for thrombosis in
patients with malignancy.2 The majority of thrombotic events
associated with malignancy occur in the venous system and the
rate of arterial thrombosis is much lower.3
Despite the serious consequences of more invasive treatment
modalities, and the higher rates of morbidity and mortality,
the association between arterial thrombosis, malignancy and
chemotherapy has not been well studied. In this report we present
a case of a patient with newly diagnosed gastric carcinoma in
whom bilateral femoral artery thrombosis developed after the
first round of chemotherapy treatment.
Case report
A 43-year-old male patient was admitted to our department with
bilateral lower limb paresthesia, pallor and pulselessness. He
had had a diagnosis of gastric carcinoma one month previously,
and he had started treatment with a chemotherapy protocol of
5-fluorouracil 750 mg/day for three days, cisplatin 40 mg/day for
three days, and taxotare 120 g/day for the initial day. After one
day of the first treatment, his symptoms began.
Physical examination showed intact sensory and motor
functions but no palpable pulses below the popliteal artery. On
Doppler ultrasonography, there were three-phasic flow patterns
on both femoral arteries, however from both popliteal arteries
there were no flow signals. In order to identify the source of
the thrombi, echocardiography was performed. There was no
intra-cardiac thrombus, wall motion disorder or arrhythmia.
Furthermore, the patient did not have a history of smoking or
Department of Cardiovascular Surgery, Gulhane Military
Academy of Medicine, Ankara, Turkey
SUAT DOGANCI, MD,
MURAT KADAN, MD
ERKAN KAYA, MD
GOKHAN EROL, MD
CELALETTIN GUNAY, MD
UFUK DEMIRKILIC, MD Fig. 1. Thrombusmaterial derived fromsurgical thrombec-
tomy.