Aortic occlusion requiring surgery in a patient with autoimmune hemolytic anemia and severe anemia: a case report.

Abstract

Introduction: Aortoiliac occlusive disease (AIOD) often requires urgent revascularization to prevent chronic limb-threatening ischemia (CLTI). The coexistence of autoimmune hemolytic anemia (AIHA) complicates surgical planning due to increased transfusion risks and unstable hemoglobin levels. Understanding the interplay between AIHA and AIOD is crucial, as delayed intervention can lead to irreversible ischemic damage.

Presentation of case: A 72-year-old man presented with leg pain and bilateral lower-limb weakness. His medical history included type 2 diabetes mellitus and suspected AIHA. Physical examination revealed necrosis in the first, second, and fourth toes of the left foot, consistent with CLTI classified as Fontaine stage IV. Laboratory findings showed severe anemia, hyperglycemia, leukocytosis, and hypoalbuminemia. CT angiography confirmed aortoiliac occlusion. Despite a suboptimal hemoglobin response to transfusion with leukodepleted packed red blood cells due to suspected AIHA, urgent revascularization was performed. The patient underwent aortoiliac endarterectomy followed by an aortobifemoral bypass using a Y-graft. Postoperative examination revealed good bilateral femoral pulses, indicating successful revascularization.

Discussion: The management of AIOD with AIHA presents a clinical dilemma. AIHA may reduce the effectiveness of perioperative transfusions, yet delaying surgery risks the progression of ischemia. Anatomical bypass to the femoral arteries restores proximal blood flow and addresses the dual concerns of thrombus progression and limb salvage.

Conclusion: Despite the hematologic challenges posed by the suspicion of AIHA, revascularization through aortobifemoral bypass remains a viable and effective treatment for CLTI caused by AIOD. This case highlights the importance of timely intervention and careful perioperative management in patients with complex comorbidities.