Cancer results in a hypercoagulable state that is associated with both venous and arterial thromboses, but little is known about the impact of acute limb ischemia (ALI) in this cohort of patients. The goal of this systematic review and meta-analysis was to analyze the available clinical data on cancer and its association with ALI and to gauge outcomes in these patients following ALI diagnosis.
Three databases including Pubmed, EMBASE, and Cochrane library were queried. Manuscripts that met the inclusion criteria were included regardless of publication year, language, sample size or length of follow-up. All steps of the meta-analysis were conducted according to PRISMA and MOOSE guidelines.
Seven manuscripts of 6,222 references were included with a total of 2,899 patients. 1,195 (41%) patients were diagnosed with ALI prior to cancer diagnosis, while 1,704 (59%) patients presented following a cancer diagnosis. Nearly three quarters of ALI events were among patients with cancers of skin and soft tissue (19%), genitourinary (18%), lung (17%), and gastrointestinal (16%) systems. ALI recurrence was similar between the two groups, while major amputation was more likely in patients diagnosed with ALI following a cancer diagnosis (7.4% vs 4.6%; p<0.01). The incidence of mortality at one year was significantly greater in patients with established cancers who presented with ALI compared to patients who presented with ALI prior to a cancer diagnosis (50.6% vs 29.9%; p<0.01). After adjusting for study variability under the random effects model, mortality at one year among all patients was 52.3% (95% CI 37.7%-66.5%). There was no significant heterogeneity (p=0.73) between the two groups of ALI patients that varied by timing in relation to cancer diagnosis.
The one-year mortality following ALI in patients with cancer is greater than 50%. In patients presenting with ALI of unclear etiology, an underlying cancer should be considered.

Copyright © 2021. Published by Elsevier Inc.
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