A 68-year-old male with Squamous Cell Lung Cancer on immunotherapy experienced two separate episodes of acute limb ischaemia secondary to tumour thromboembolism, including simultaneous bilateral lower limb involvement, despite therapeutic anticoagulation.
Key Findings
Background
Acute limb ischaemia (ALI) can occur as a manifestation of malignant thromboembolism in patients with active lung cancer, even in the absence of typical cardiovascular risk factors as the primary cause.
The patient was a 68-year-old Caucasian male with known Squamous Cell Lung Cancer on immunotherapy.
The ALI was attributed to tumour thromboembolism rather than atherosclerotic disease alone.
The case occurred in the context of active malignancy, which is described as a less common but increasingly recognized association with ALI.
Results
The patient experienced two separate episodes of ALI, with the first involving the left upper limb and the second involving both lower limbs simultaneously.
The first episode was managed surgically with a brachial embolectomy.
The second episode involved bilateral lower limb ischaemia simultaneously, a particularly rare presentation.
The second episode was also treated successfully with surgery.
The patient required a prolonged period of rehabilitation before discharge.
Results
Recurrent ALI due to malignant thromboembolism occurred despite the patient being on therapeutic anticoagulation.
The patient was on ongoing therapeutic anticoagulation following the first episode of ALI.
Despite this anticoagulation, a second episode of ALI still occurred, affecting both lower limbs.
This finding highlights a limitation of standard anticoagulation therapy in preventing tumour-related thromboembolism.
Results
During the inpatient stay for the second episode of ALI, the patient was found to have new cerebral metastases, indicating disease progression.
New cerebral metastases were discovered during the hospitalization for bilateral lower limb ALI.
The authors note that such ALI presentations may indicate disease progression in oncological patients.
The authors underscore that recurrent ALI in cancer patients may indicate a poorer prognosis.
Discussion
This case underscores the need for early oncology involvement when cancer patients present with ALI, as it may signal disease progression.
The authors highlight that ALI in oncological patients is not due solely to atherosclerotic disease.
Early oncology involvement is recommended given that ALI presentations may indicate disease progression.
The case contributes to growing evidence regarding the association between active malignancy and ALI.
The authors note that such presentations may indicate a poorer prognosis for oncological patients.
What This Means
This research describes the case of a 68-year-old man with squamous cell lung cancer who was receiving immunotherapy and developed a dangerous condition called acute limb ischaemia (ALI) — where blood supply to a limb is suddenly cut off — on two separate occasions. The first episode affected his left arm and was treated with surgery to remove the clot. The second episode, which happened despite the patient being on blood thinners, affected both legs at the same time. Both episodes were caused by clots originating from his tumor (tumour thromboembolism) rather than the more common cause of hardened arteries. During his hospital stay for the second episode, doctors also discovered that his cancer had spread to his brain.
This case is significant because it shows that cancer patients can develop acute limb ischaemia through a different mechanism than the general population, and that standard blood-thinning medications may not be enough to prevent recurrence in these patients. The simultaneous involvement of both legs is an especially rare and serious presentation. The discovery of new brain metastases during the same hospital admission suggests that episodes of ALI in cancer patients may be a warning sign that the disease is progressing.
This research suggests that when a cancer patient develops acute limb ischaemia, doctors should consider tumor-related causes alongside the more typical cardiovascular causes, and that oncology specialists should be involved early in the patient's care. Such presentations may carry important implications for understanding the stage and trajectory of a patient's cancer, and may require treatment approaches tailored to the underlying malignancy rather than standard cardiovascular protocols alone.
Au A, Choy A, Yii M. (2026). Recurrent Acute Limb Ischaemia due to Malignant Thromboembolism Involving Bilateral Lower Limbs Simultaneously.. Cancer reports (Hoboken, N.J.). https://doi.org/10.1002/cnr2.70591