Regional block anesthesia in a patient with factor V Leiden mutation and axillary artery occlusion

Kerem Erkalp¹, Mevlut Comlekci¹, Bekir Inan², Gokcen Basaranoglu¹, Haluk Ozdemir¹, Leyla Saidoglu^1
1Department of Anaesthesiology and Reanimation, Vakif Gureba Hospital, Istanbul, Turkey; ²Department of Vascular Surgery, Vakif Gureba Hospital, Istanbul, Turkey

Abstract: Anesthetic management of patients with coagulation disorders presents safety and technical challenges. This case describes a 58-year-old woman with factor V Leiden mutation who required distal saphenous vein harvest and axillo-brachial bypass to treat axillary artery occlusion. The patient underwent surgery with satisfactory anesthesia using infraclavicular brachial plexus block, thoracic paravertebral block, and unilateral subarachnoid block. These three regional anesthetic interventions were performed in lieu of general anesthesia to minimize risks of thrombotic events, pain, and to decrease recovery time. Despite higher failure rates of regional anesthesia, longer time required for procedures, and added discomforts during surgery, the benefits may outweigh risks for selected high-risk patients, including those with factor V Leiden mutations.

Keywords: regional anesthesia, factor V Leiden, pain, vein harvest