Patients with malignancy are at an increased risk of arterial thrombosis; however, spinal cord infarction (SCI) secondary to aortic mural thrombosis is rare. The present report describes a case of SCI in a 75-year-old man with cancer of unknown primary undergoing chemotherapy and immune checkpoint inhibitor (ICI) therapy. The patient presented with acute bilateral lower limb weakness and bladder-rectal dysfunction. Although spinal cord compression was initially suspected due to multiple vertebral metastases, contrast-enhanced magnetic resonance imaging revealed no evidence of compression or leptomeningeal dissemination. Diffusion-weighted imaging demonstrated hyperintensity with reduced apparent diffusion coefficient values in the spinal cord, consistent with SCI. Immune-related adverse event-associated myelitis was excluded based on cerebrospinal fluid analysis. Contrast-enhanced computed tomography revealed a large aortic mural thrombus, which was considered the most likely etiology of SCI after exclusion of alternative causes. Anticoagulation therapy combined with early rehabilitation led to partial neurological recovery. This case underscores the importance of considering SCI in the differential diagnosis of acute neurological deficits in patients with malignancy receiving ICI therapy.

Acute limb ischemia is a vascular emergency that requires prompt diagnosis and treatment to avoid permanent tissue loss and possible amputation. Recurrent arterial thrombosis in a relatively young patient, especially while on anticoagulation, should raise concern for an underlying hypercoagulable state. We present the case of a 40-year-old woman with type 2 diabetes mellitus, hyperlipidemia, and heavy tobacco use who developed acute right lower extremity ischemia after sitting with her legs crossed for several hours during an episode of severe vomiting and diarrhea. She underwent emergent thromboembolectomy and was discharged on apixaban and aspirin. About two weeks later, she returned with recurrent right lower extremity ischemia despite reported compliance with anticoagulation and was found to have multifocal arterial thrombosis requiring repeat thromboembolectomy and pedal arch angioplasty. Her postoperative leukocytosis was felt to be reactive and related to ischemia-reperfusion injury rather than infection. Because of recurrent arterial thrombosis despite apixaban therapy, further workup for antiphospholipid syndrome was initiated, and she was transitioned to heparin with recommendation for long-term warfarin therapy. This case highlights that mechanical compression may have contributed to the initial lower extremity ischemic event; however, the subsequent recurrent arterial thromboses, particularly at anatomically distinct sites despite direct oral anticoagulant (DOAC) therapy, were more concerning for an underlying systemic hypercoagulable state such as antiphospholipid syndrome in the setting of additional vascular risk factors.

Acute limb ischemia is an uncommon but potentially limb-threatening complication in pediatric patients. Arterial thrombosis secondary to iatrogenic vascular trauma during vascular access procedures in children has been described in the literature, most frequently following catheter-based interventions involving the femoral artery. In contrast, cases arising after inadvertent arterial puncture during femoral venous catheterization are only rarely reported. We describe the case of a 13-month-old child who developed acute ischemia of the right lower limb following accidental femoral artery puncture during a single attempt at femoral central venous catheterization using the landmark technique, performed by a senior operator experienced in pediatric vascular access. A 4-Fr catheter was inserted via the Seldinger technique. Despite initially reassuring procedural indicators and prompt manual compression after the error was recognized, the patient developed clinical signs of acute arterial occlusion. Imaging confirmed the diagnosis, and emergency thrombectomy was successfully performed, resulting in a favorable outcome. This case is particularly instructive because it demonstrates that severe acute limb ischemia may occur after a single landmark-guided femoral venous puncture, even when performed by an experienced operator. It highlights the importance of routine ultrasound guidance for central venous access in pediatric patients, and the need for careful postoperative clinical monitoring to enable early recognition and prompt management of such complications.

Thoracic outlet syndrome (TOS) encompasses a spectrum of disorders caused by compression of neurovascular structures at the thoracic outlet. Arterial thoracic outlet syndrome (aTOS) is rare, accounting for less than 1% of cases, yet carries significant morbidity due to arterial injury, thrombosis, and distal embolization. We present a 34-year-old woman with progressive pain, paresthesia, and bluish discoloration of the left upper limb. Doppler ultrasound demonstrated reduced ulnar artery calibre with a tardus-parvus waveform, indicating distal arterial compromise. CT angiography revealed a fused cervical rib causing focal compression of the left subclavian artery with associated poststenotic dilatation. The patient underwent surgical decompression with cervical rib excision, thrombus evacuation, and arterial reconstruction, resulting in restoration of distal perfusion. Postoperatively, MRI of the shoulder-performed for persistent pain-demonstrated edema of the infraspinatus and teres minor muscles without fatty infiltration, suggestive of acute denervation edema. This case illustrates the full imaging continuum of aTOS, from structural vascular compression and distal ischemia to postoperative neural involvement, underscoring the critical role of multimodality imaging in both diagnosis and follow-up.

Calciphylaxis is a life-threatening complication of end-stage renal disease (ESRD) characterized by painful necrotic skin lesions resulting from small-vessel (arteriolar) calcification, thrombosis, and subsequent ischemic tissue necrosis. However, not all ischemic lesions in dialysis patients represent calciphylaxis. We present a 44-year-old man with ESRD on hemodialysis who developed progressive bilateral digital necrosis initially suggestive of calciphylaxis, given severe hyperphosphatemia and secondary hyperparathyroidism. Lesion morphology demonstrated well-demarcated distal gangrene without retiform purpura or induration, features atypical for calciphylaxis. Multimodal evaluation revealed an alternative diagnosis. Radiographs demonstrated extensive medial arterial calcification, while noninvasive vascular testing showed markedly reduced ankle-brachial indices and abnormal pulse volume recordings. Duplex ultrasonography identified hemodynamically significant arterial disease, and magnetic resonance imaging confirmed soft-tissue nonviability without osteomyelitis. Collectively, these findings supported acute limb ischemia secondary to advanced calcific peripheral arterial disease rather than calciphylaxis. The patient was managed with a vascular-focused approach, including evaluation for revascularization and surgical planning. This case highlights a critical diagnostic pitfall in ESRD, where dialysis-associated vascular calcification may mimic calciphylaxis while representing macrovascular occlusive disease. Accurate differentiation through careful clinical assessment and multimodal vascular evaluation is essential, as management strategies and outcomes differ substantially.

Background and Objectives: Acute or severe limb ischemic events are limb- and life-threatening complications of peripheral artery disease (PAD). Although cirrhosis is increasingly recognized as a systemic disorder associated with endothelial dysfunction, inflammation, and altered hemostatic balance, its relationship with coding-defined limb ischemic events among individuals with PAD remains poorly defined. We investigated whether cirrhosis is independently associated with coding-defined acute or severe limb ischemic events among hospitalized adults with PAD. Materials and Methods: We performed a retrospective discharge-level analysis of the National Inpatient Sample from 2016 to 2018. Adult hospitalizations with PAD were identified using ICD-10-CM diagnosis codes and stratified according to the presence or absence of cirrhosis. The primary outcome was coding-defined acute or severe limb ischemic events. Multivariable logistic regression was used to evaluate the association between cirrhosis and acute or severe limb ischemic events after adjustment for demographic and cardiovascular comorbidities. Propensity-score matching was additionally performed to balance baseline characteristics between hospitalizations with and without cirrhosis. Results: Among 276,702 hospitalizations with PAD, 5942 had cirrhosis. Before matching, cirrhosis was independently associated with higher odds of acute or severe limb ischemic events after multivariable adjustment (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.35-1.60; p < 0.001). After 1:1 propensity-score matching, 5883 matched pairs were analyzed. The association between cirrhosis and acute or severe limb ischemic events persisted in the matched cohort, with cirrhosis remaining significantly associated with increased odds of these events (OR 1.41, 95% CI 1.24-1.60; p < 0.001). Conclusions: In this large discharge-level analysis of hospitalizations with PAD, cirrhosis was independently associated with higher odds of coding-defined acute or severe limb ischemic events. These findings suggest that cirrhosis may represent an underrecognized vascular risk amplifier in PAD. Further prospective studies are needed to validate this association, clarify underlying mechanisms, and determine whether cirrhosis may improve PAD risk stratification.

A persistent sciatic artery is a rare congenital vascular anomaly resulting from the failed regression of the sciatic artery during fetal development. It is associated with complications such as thrombosis, aneurysm formation, and acute limb ischemia. A 49-year-old female presented with acute limb ischemia of the left lower limb. Computed tomography angiography confirmed bilateral persistent sciatic arteries with thrombosis affecting only the left limb. She underwent successful endovascular balloon angioplasty and percutaneous thrombectomy, resulting in symptom resolution. Acute limb ischemia is the second most common presentation of persistent sciatic artery, occurring in 33.3% of cases. While computed tomography angiography is the gold standard for diagnosis, magnetic resonance angiography has been used in select cases. Management includes conservative treatment, endovascular intervention, or surgical repair. A bilateral persistent sciatic artery with unilateral thrombosis is rare. Early diagnosis and appropriate intervention, such as endovascular therapy, are essential to prevent complications. Long-term vascular surveillance is crucial for optimal patient outcomes.