Cryptogenic acute lower extremities and multiorgan ischemia in an 8-year-old girl

Abstract

Pediatric acute limb ischemia is rare but can have devastating effects on children. The most common causes of acute limb ischemia in the pediatric age group are iatrogenic injury during cardiac catheterization and traumatic vessel injury. Embolic events have been described less often. We present the case of an 8-year-old girl with cryptogenic extensive bilateral lower extremity ischemia and embolization to multiple visceral organs. Our findings have highlighted the importance of interdisciplinary workup, timely intervention, and the advantage of intraoperative imaging for revascularization.

Keywords: Acute limb ischemia; Pediatric; Surgical embolectomy; Thromboembolism.

Fig 1

Computed tomography angiograms demonstrating complete occlusion of the left external iliac artery (EIA; A; arrow), bilateral occlusion of the common femoral arteries (CFAs; B; arrows). C, The popliteal artery in the right leg was completely occluded and minimally patent in the left leg. D, In the right leg, no filling was present in the tibioperoneal trunk, anterior tibial artery, posterior tibial artery, or peroneal artery, with no runoff branches. In the left leg, the anterior tibial artery was minimally patent; however, the tibioperoneal trunk and all other branches were occluded.

Fig 2

Arteriograms after embolectomy demonstrating restoration of flow bilaterally, with reconstitution in the iliac arteries, bilateral common femoral arteries (CFAs), profunda femoral arteries, superficial femoral arteries (A,B), bilateral popliteal arteries, tibioperoneal trunks, and branches (C). D, The anterior tibial arteries and posterior tibial arteries were also restored with satisfactory runoff.