Distal ischemic changes related to combination chemotherapy with cisplatin and gemcitabine: description of four cases.

Cancer chemotherapeutic agents have been related to three main forms of vascular toxicity: 1) Veno-occlusive disease of hepatic vessels or in rare instances, of pulmonary vessels [1]. 2) Venous or arterial thrombosis [2]. 3) Vascular ischemia involving cerebral, myocardial, or extremity arterial vessels [3]. The number of agents implicated in these toxicities is increasing (Table 1), although the precise pathogenesis of these toxic e¡ects has not been elucidated. Vascular changes may also be related to the underlying neoplasms or to unrecognized previous vascular disease, e.g., tobacco-related. Distal arterial ischemia is a rare complication induced by chemotherapy, and may be associated with preexistent organic changes. In the present article we report four cases of lung cancer and peripheral ischemia during chemotherapy with cisplatin and gemcitabine.