Vascular limb occlusion in twin-twin transfusion syndrome (TTTS): Case series and literature review

Susanne Schrey; Agnes Huber; Kurt Hecher; Rubén Quintero; Fawaz Alkazaleh; Kenneth J. Moise; John R. Allbert; Carol Schneider; Mario Palermo; Yoav Yinon; Ramen H. Chmait; Rory Windrim; Greg Ryan

doi:10.1016/j.ajog.2012.06.005

Vascular limb occlusion in twin-twin transfusion syndrome (TTTS): Case series and literature review

Susanne Schrey, Agnes Huber, Kurt Hecher, Rubén Quintero, Fawaz Alkazaleh, Kenneth J. Moise, John R. Allbert, Carol Schneider, Mario Palermo, Yoav Yinon, Ramen H. Chmait, Rory Windrim, Greg Ryan^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

19 Scopus citations

Abstract

Objective: The purpose of this study was to evaluate the phenomenon of vascular ischemic limb necrosis in twin-twin transfusion syndrome (TTTS). Study Design: This was a multicenter retrospective review of ischemic limb necrosis in patients with TTTS. Results: Twenty cases of fetal ischemic limb necrosis in association with TTTS were identified from 10 fetal medicine centers. The recipient was affected in 19 cases, and the lower limb was affected in 17 cases. The extent of the damage correlated with TTTS severity. Eighty percent of limb defects (16/20) clearly were unrelated to laser treatment (3 cases untreated, 7 cases after amnioreduction, 6 cases present at time of laser). The recipient was relatively polycythemic in 5 of 7 cases in which neonatal or fetal hemoglobin/hematocrit levels were available. Conclusion: Ischemic limb necrosis is a rare complication of TTTS. The lesion is unrelated to therapy and may be the result of polycythemia, hypertension, and vasoconstriction.

Original language	English
Pages (from-to)	131.e1-131.e10
Journal	American Journal of Obstetrics and Gynecology
Volume	207
Issue number	2
DOIs	https://doi.org/10.1016/j.ajog.2012.06.005
State	Published - Aug 2012
Externally published	Yes

Keywords

limb defect
limb necrosis
pregnancy
twin-twin transfusion syndrome (TTTS)

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10.1016/j.ajog.2012.06.005

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Schrey, S., Huber, A., Hecher, K., Quintero, R., Alkazaleh, F., Moise, K. J., Allbert, J. R., Schneider, C., Palermo, M., Yinon, Y., Chmait, R. H., Windrim, R., & Ryan, G. (2012). Vascular limb occlusion in twin-twin transfusion syndrome (TTTS): Case series and literature review. American Journal of Obstetrics and Gynecology, 207(2), 131.e1-131.e10. https://doi.org/10.1016/j.ajog.2012.06.005

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title = "Vascular limb occlusion in twin-twin transfusion syndrome (TTTS): Case series and literature review",

abstract = "Objective: The purpose of this study was to evaluate the phenomenon of vascular ischemic limb necrosis in twin-twin transfusion syndrome (TTTS). Study Design: This was a multicenter retrospective review of ischemic limb necrosis in patients with TTTS. Results: Twenty cases of fetal ischemic limb necrosis in association with TTTS were identified from 10 fetal medicine centers. The recipient was affected in 19 cases, and the lower limb was affected in 17 cases. The extent of the damage correlated with TTTS severity. Eighty percent of limb defects (16/20) clearly were unrelated to laser treatment (3 cases untreated, 7 cases after amnioreduction, 6 cases present at time of laser). The recipient was relatively polycythemic in 5 of 7 cases in which neonatal or fetal hemoglobin/hematocrit levels were available. Conclusion: Ischemic limb necrosis is a rare complication of TTTS. The lesion is unrelated to therapy and may be the result of polycythemia, hypertension, and vasoconstriction.",

keywords = "limb defect, limb necrosis, pregnancy, twin-twin transfusion syndrome (TTTS)",

author = "Susanne Schrey and Agnes Huber and Kurt Hecher and Rub{\'e}n Quintero and Fawaz Alkazaleh and Moise, {Kenneth J.} and Allbert, {John R.} and Carol Schneider and Mario Palermo and Yoav Yinon and Chmait, {Ramen H.} and Rory Windrim and Greg Ryan",

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doi = "10.1016/j.ajog.2012.06.005",

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Schrey, S, Huber, A, Hecher, K, Quintero, R, Alkazaleh, F, Moise, KJ, Allbert, JR, Schneider, C, Palermo, M, Yinon, Y, Chmait, RH, Windrim, R & Ryan, G 2012, 'Vascular limb occlusion in twin-twin transfusion syndrome (TTTS): Case series and literature review', American Journal of Obstetrics and Gynecology, vol. 207, no. 2, pp. 131.e1-131.e10. https://doi.org/10.1016/j.ajog.2012.06.005

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T1 - Vascular limb occlusion in twin-twin transfusion syndrome (TTTS)

T2 - Case series and literature review

AU - Schrey, Susanne

AU - Huber, Agnes

AU - Hecher, Kurt

AU - Quintero, Rubén

AU - Alkazaleh, Fawaz

AU - Moise, Kenneth J.

AU - Allbert, John R.

AU - Schneider, Carol

AU - Palermo, Mario

AU - Yinon, Yoav

AU - Chmait, Ramen H.

AU - Windrim, Rory

AU - Ryan, Greg

PY - 2012/8

Y1 - 2012/8

N2 - Objective: The purpose of this study was to evaluate the phenomenon of vascular ischemic limb necrosis in twin-twin transfusion syndrome (TTTS). Study Design: This was a multicenter retrospective review of ischemic limb necrosis in patients with TTTS. Results: Twenty cases of fetal ischemic limb necrosis in association with TTTS were identified from 10 fetal medicine centers. The recipient was affected in 19 cases, and the lower limb was affected in 17 cases. The extent of the damage correlated with TTTS severity. Eighty percent of limb defects (16/20) clearly were unrelated to laser treatment (3 cases untreated, 7 cases after amnioreduction, 6 cases present at time of laser). The recipient was relatively polycythemic in 5 of 7 cases in which neonatal or fetal hemoglobin/hematocrit levels were available. Conclusion: Ischemic limb necrosis is a rare complication of TTTS. The lesion is unrelated to therapy and may be the result of polycythemia, hypertension, and vasoconstriction.

AB - Objective: The purpose of this study was to evaluate the phenomenon of vascular ischemic limb necrosis in twin-twin transfusion syndrome (TTTS). Study Design: This was a multicenter retrospective review of ischemic limb necrosis in patients with TTTS. Results: Twenty cases of fetal ischemic limb necrosis in association with TTTS were identified from 10 fetal medicine centers. The recipient was affected in 19 cases, and the lower limb was affected in 17 cases. The extent of the damage correlated with TTTS severity. Eighty percent of limb defects (16/20) clearly were unrelated to laser treatment (3 cases untreated, 7 cases after amnioreduction, 6 cases present at time of laser). The recipient was relatively polycythemic in 5 of 7 cases in which neonatal or fetal hemoglobin/hematocrit levels were available. Conclusion: Ischemic limb necrosis is a rare complication of TTTS. The lesion is unrelated to therapy and may be the result of polycythemia, hypertension, and vasoconstriction.

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KW - limb necrosis

KW - pregnancy

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ER -

Vascular limb occlusion in twin-twin transfusion syndrome (TTTS): Case series and literature review

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Keywords

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