Case report: Recurrent arterial thrombosis in a patient with polycythemia vera

Abstract Background Arterial thrombosis of the lower extremities is a common emergency in vascular surgery that can easily lead to amputation due to acute limb ischemia if not managed promptly. Arterial thrombosis of lower extremities is often associated with atherosclerosis, but some rare conditions, such as polycythemia vera, can also induce thrombosis. Polycythemia vera is prone to thrombosis because of its special pathological features. In addition, the thrombus sites are common in brain blood vessels and coronary arteries. Conversely, thrombosis occurring in the lower limbs is rare. Case presentation: A 44-year-old man with an about 20 years history of hypertension and smoking presented to the emergency department and transferred to department of vascular surgery after low molecular weight heparin administered due to acute thrombosis of lower extremities in May 2019. Laboratory tests revealed that his hemoglobin and hematocrit levels elevated, and a diagnosis of chronic polycythemia was considered. At that time, the patient’s thrombosis was not connected to polycythemia. After discharge, the patient was advised to visit the hematology department for further diagnosis confirmation. However, the patient did not comply. In August 2019, the patient was admitted to the hospital for the second time due to arterial thromboembolism in the left lower limb. After discharge, the patient completed a bone marrow biopsy and genetic testing and was diagnosed with polycythemia vera. Unfortunately, the patient has suffered from arterial thrombosis of lower limbs in September 2019, November 2019, December 2019, and October 2022 because of the non-standard treatment. Conclusions It is important to determine the etiology of patients with arterial thrombosis of lower extremities especially recurrent thrombosis as well as pay attention to some rare causes that can induce thrombosis. Standard treatment is vital for patients to prevent recurrent thrombosis when there are some specific etiologies as in our present case.