Massive Lower Extremity Arterial Thrombosis and Acute Hepatic Insufficiency in a Young Adult with Premature Atherosclerosis Associated with Hyperlipoprotein(a)emia and Antiphospholipid Syndrome

Abstract

The authors describe a healthy young male smoker with familial history of recurrent thromboembolism who presented with severe, rapidly progressive lower limb ischemia and abnormal results from liver function tests. An arteriogram of the lower extremities showed bilateral infrainguinal atherosclerotic arterial occlusions. The laboratory findings, in addition to abnormal liver function findings, included moderately elevated antiphos pholipid antibodies and hemostatic abnormalities involving elevated fibrinogen, lipopro tein (a) levels, and deficient fibrinolysis. He underwent bilateral femoral thrombectomy, which was followed by a meticulous anticoagulation, and had gradual improvement of ischemic symptoms and liver functions. This is, to their knowledge, the first reported case in the English literature of premature lower extremity atherosclerosis and antiphos pholipid syndrome associated with elevated lipoprotein (a) levels and documented complex hemostatic abnormalities contributing to systemic thrombosis.