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

Am J Obstet Gynecol. 2012 Aug;207(2):131.e1-10. doi: 10.1016/j.ajog.2012.06.005. Epub 2012 Jun 11.


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.

Publication types

  • Multicenter Study
  • Review
  • Video-Audio Media

MeSH terms

  • Amputation, Surgical
  • Female
  • Fetal Death
  • Fetofetal Transfusion / complications*
  • Humans
  • Infant, Newborn
  • Ischemia / etiology*
  • Laser Coagulation
  • Lower Extremity / blood supply*
  • Lower Extremity / pathology
  • Lower Extremity / surgery
  • Necrosis
  • Pregnancy
  • Pregnancy Reduction, Multifetal
  • Retrospective Studies
  • Severity of Illness Index
  • Upper Extremity / blood supply*
  • Upper Extremity / pathology
  • Upper Extremity / surgery