Annals of Vascular Surgery - Brief Reports and Innovations · Published 2026-07-17 · DOI 10.1016/j.avsurg.2026.100475
George Liu, J Sheppard Mondy, E Jerry Cohn
Background: Malignancy promotes a hypercoagulable state that can lead to vascular complications, including the rare phenomenon malignant arterial tumor embolism (MATE). MATE is an underrecognized vascular manifestation that may present with acute limb ischemia or organ infarction and carries a poor prognosis. We present the only documented case of multiple MATE involving the brachial, femoral, and popliteal arteries in a patient with recurrent uterine leiomyosarcoma (uLMS). Case presentation: A 53-year-old woman with stage IB uLMS underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. She subsequently developed pulmonary nodules suspicious for metastatic disease but declined chemotherapy, opting instead for holistic management. Shortly after, she presented with acute right upper extremity ischemia, and imaging revealed a brachial artery occlusion, which was successfully treated with embolectomy. In the following weeks, she experienced recurrent arterial embolic events involving the right femoral and left popliteal arteries. Embolectomy of the femoral occlusion was performed, and histopathology confirmed tumor emboli. Her final embolic episode was managed conservatively, and she died later that year. Discussion: This is the only documented case of MATE with sequential embolization to multiple peripheral arteries within both upper and lower extremities. Peripheral arterial tumor embolism is exceedingly rare and poorly understood. This recurrence highlights the need for operative intervention along with systemic disease control. Conclusion: MATE should be considered in patients with malignancy presenting with unexplained arterial embolism. Timely surgical intervention, long-term anticoagulation, and systemic therapy must be considered, along with proactive patient counseling to optimize outcomes.
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Liu, G., Mondy, J., Cohn, E. (2026). Recurrent acute limb ischemia secondary to tumor embolism: A rare malignant manifestation. Annals of Vascular Surgery - Brief Reports and Innovations. https://doi.org/10.1016/j.avsurg.2026.100475