Thrombectomy in HIV Related Peripheral Arterial Thrombosis: A Preliminary Report

Abstract

Limb salvage rate following thrombectomy in HIV related peripheral arterial thrombosis is very low. Duplex ultrasonography appears to be an adequate radiological diagnostic investigation for these patients.

Gangrene Associated with Human Immunodeficiency Virus (HIV)

“…Another reason for the low incidence of peripheral vascular disease is because we did not screen for any subclinical vascular disease in our patients. As observed in our cases CD4 counts in patients with HIV vasculopathy are below normal in more than 90% of patients and the CD4:CD8 ratio is usually reversed, indicative of advanced immunosuppression (Mulaudzi et al, 2005).…”

“…Where the limb is salvageable treatment options include endovascular procedures like thrombectomy and thrombolysis or bypass procedures. However, the limb salvage rate has been in the region of 27% (Mulaudzi et al, 2005). This is thought to be due to the fact that it is mainly a vasculitic process with superimposed thrombosis, and removing the thrombus does not, in effect, solve the problem, which has a very high rethrombosis rate 3 .…”

“…Median age of patients is between 30 -40 years (Mulaudzi et al, 2005). Male preponderance has been observed in HIV associated vasculopathy (Mulaudzi et al, 2005).…”

“…HIV vasculopathy was first described as an entity in 1987 (Joshi et al, 1987). HIV associated vasculopathy may present with arterial occlusive disease, aneurysmal disease, aortic dissection or spontaneous arteriovenous fistula (Mulaudzi, 2005;Nair, 1999Nair, , 2000Nair, , 2001Pantula, 2009). Vasculitis is one of the less common but important consequences of HIV (Chetty, 2001).…”

An unexpected cause of digital gangrene: HIV associated peripheral arterial thrombosis

“…Among most patients critical ischaemia is confined to one limb and, in particular, the lower limbs. 2 The increased incidence of peripheral arterial disease in HIV infection may be explained, in part, by dyslipidaemia associated with chronic HIV infection and/or antiretroviral treatment (ART) interruptions as shown by the SMART study. 3 Metabolic side effects of HIV and ART such as lipodystrophy, diabetes mellitus, and insulin resistance may also be associated with premature development of artherosclerosis.…”