Arterial Thrombosis at High Altitude Resulting in Loss of Limb

Vascular thrombosis is an uncommon but recognized peril of high altitude travel. Traditionally, this has been associated with prolonged exposure to extreme altitudes where dehydration, hemoconcentration, cold, use of constrictive clothing, and enforced stasis due to severe weather have been named as contributing factors. It is widely hypothesized that hypoxia itself alters the coagulation cascade to create a prothrombotic milieu, though evidence thus far is limited and frequently conflicting. Case reports have described venous thrombosis, pulmonary embolism, cerebrovascular accidents, transient ischemic attacks, and thromboses of the portal circulation at altitude. We report a unique case of aortic thrombosis presenting with critical lower extremity ischemia in a previously healthy individual after a brief exposure to altitudes up to 4620 m. None of the frequently invoked risk factors of dehydration, cold, enforced use of constrictive clothing, weather-imposed inactivity, or extreme altitude were present, and no medical predisposition to thrombosis was identified, suggesting hypoxia as the most likely prothrombotic stimulus. We discuss the treatment of this problem and the application of Doppler ultrasonography in a wilderness setting.