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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Acute lower extremity arterial thrombosis after intraocular foreign body removal under general anesthesia: A case report and review of literature
Soeun Jeon, Jeong-Min Hong, Hyeon Jeong Lee, Eunsoo Kim, Hyunju Lee, Yesul Kim, Hyun-Su Ri, Jae Jung Lee
Soeun Jeon, Jeong-Min Hong, Hyeon Jeong Lee, Eunsoo Kim, Hyunju Lee, Yesul Kim, Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Busan 49241, South Korea
Soeun Jeon, Jeong-Min Hong, Hyeon Jeong Lee, Eunsoo Kim, Jae Jung Lee, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
Hyun-Su Ri, Department of Anesthesia and Pain Medicine, Kyungpook National University, School of Medicine, Daegu 41944, South Korea
Jae Jung Lee, Department of Ophthalmology, College of Medicine, Pusan National University, School of Medicine, Yangsan 50612, South Korea
Author contributions: Jeon S and Hong JM designed the study; Jeon S, Hong JM and Ri HS drafted the manuscript; Lee H, Kim Y and Lee JJ collected data and pictures; Jeon S, Hong JM, Lee HJ, Kim E and Ri HS reviewed the literature and edited the manuscript; all authors agreed to be accountable for all aspects of the work; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jeong-Min Hong, MD, PhD, Assistant Professor, Doctor, Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, 179 Gudeok-ro, Seo-gu, Busan 49241, South Korea. ccarrot@pusan.ac.kr
Received: May 4, 2021
Peer-review started: May 4, 2021
First decision: June 24, 2021
Revised: July 8, 2021
Accepted: August 11, 2021
Article in press: August 11, 2021
Published online: September 26, 2021
BACKGROUND
Surgery, which is a major risk factor for venous thrombosis, has rarely been considered a risk factor for arterial thrombosis. Recent studies have suggested that venous and arterial thromboses share common risk factors and have a bidirectional relationship. Accordingly, there is a growing interest in the risk of arterial thrombosis after surgery. We report a case of acute bilateral lower extremity arterial thromboses that developed after a prolonged surgery.
CASE SUMMARY
A 59-year-old man was hospitalized for intraocular foreign body removal surgery. He was a heavy-drinking smoker and had untreated hypertension and varicose veins in both legs. The operation was unexpectedly prolonged, lasting 4 h and 45 min. Immediately after emergence from general anesthesia, the patient complained of extreme pain in both legs. After the surgical drape was removed, cyanosis was evident in both feet of the patient. The pulse was not palpable, and continuous-wave Doppler signals were inaudible in the bilateral dorsalis pedis and posterior tibial arteries. Computed tomography angiography confirmed acute bilateral thrombotic occlusion of the popliteal arteries, proximal anterior tibial arteries, and tibioperoneal trunks. Arterial pulse returned in both lower limbs after 6 h of heparin initiation. The patient was discharged on postoperative day 26 without any sequelae.
CONCLUSION
Acute lower extremity arterial thrombosis can occur after surgery. Anesthesiologists should pay particular attention to patients with risk factors for thrombosis.
Core Tip: The conventional literature emphasizes that surgery is a major risk factor for venous thrombosis rather than arterial thrombosis. However, recent studies have suggested that these two types of thromboses are closely related and share common risk factors. Accordingly, there has been a growing interest in the increased postoperative risk of arterial thrombosis. We report the case of a patient with multiple risk factors, who developed acute bilateral arterial thromboses of the lower limbs after an unexpectedly prolonged surgery. Although postoperative arterial thrombosis of the lower extremity is rare, anesthesiologists should pay particular attention to patients with risk factors for thrombosis.
