A Case of Severe Limb Ischemia Due to Distal Peroneal Artery Thromboembolization with Popliteal Arterial Variants

Abstract

We report a case of acute limb ischemia (ALI) in a patient with popliteal arterial variants. The patient was a 77-year-old woman who was referred to our hospital due to left lower limb pain persisting for 4 days. Contrast-enhanced computed tomography (CT) scans revealed an obstruction suggestive of an embolism in the distal peroneal artery, with patency being observed below the posterior tibial artery at the ankle level due to collateral circulation. Based on a diagnosis of ALI: Grade 1, the patient was hospitalized for conservative therapy; however, ischemic symptoms in the patient’s left limb rapidly worsened after admission, and rest pain and cyanosis were observed. A re-review of the initial contrast-enhanced CT images revealed defects in the unaffected side of the posterior tibial artery and hypoplasia in the anterior tibial artery. The peroneal artery was thought to have flowed directly into the plantar artery, causing the anomaly of popliteal artery. Thereafter, a thrombectomy was performed for the peroneal artery. A dark red fresh thrombus was removed successfully and improvement in blood flow was observed. The possibility of angiodysplasia should be considered, and making an accurate diagnosis and an appropriate decision among treatment options was considered important.