Slovenská chirurgia 1e/2026

Hybrid treatment of acute limb ischemia caused by thromboembolization from a common iliac artery aneurysm: a case report

Introduction: Acute limb ischemia (ALI) is a serious condition associated with a high risk of limb loss and mortality. Thromboembolism originating from a common iliac artery aneurysm is a rare cause of ALI.

Case report: This case report describes a 74-year-old patient admitted with Rutherford category IIb acute ischemia of the right lower limb caused by thromboembolism originating from an aneurysmally dilated common iliac artery. The patient underwent urgent surgical embolectomy of the iliac and femoral arteries, followed by hybrid endovascular treatment of the aneurysm with stent and stent-graft implantation. Due to residual distal embolization, local continuous thrombolysis and subsequent endovascular revascularization of the infrapopliteal arteries were performed. The postoperative course was complicated by reperfusion syndrome and acute kidney injury, which required conservative treatment. At discharge, both lower limbs were viable, adequately perfused, and without sensory or motor deficit.

Conclusion: Acute limb ischemia may be the first clinical manifestation of a previously undiagnosed common iliac artery aneurysm. This case report highlights the importance of a hybrid revascularization approach in complex multilevel arterial disease and the need for early recognition and treatment of reperfusion-related complications.

Keywords: acute limb ischemia, common iliac artery aneurysm, thromboembolism, hybrid revascularization, reperfusion syndrome