Rare Presentation of Acute Lower Limb Ischemia: Saddle Aortic Embolus with Paraplegia - Case Report

Abstract Introduction: This case report presents a unique and noteworthy occurrence of acute lower limb ischemia (ALI) accompanied by paraplegia in a 60-year-old male patient with a medical history of diabetes mellitus, hypertension, and ischemic heart disease. The novelty of this case lies in the rare association of ALI with paraplegia, which is an unusual and infrequently reported condition. Case presentation: A patient who underwent coronary artery bypass graft (CABG) surgery presented 12 days post-surgery with sudden onset right lower limb pain followed by paralysis in both lower limbs. Initially, Guillain-Barré syndrome (GBS) was suspected; however, further evaluation revealed occlusion in the abdominal aorta, common iliac artery, and external iliac arteries. The patient's management involved prompt diagnosis, administration of intravenous heparin, bilateral leg fasciotomy, and thrombectomy. These interventions resulted in the restoration of pulses and improvement in the patient's condition. Nonetheless, postoperative complications in the form of acute kidney injury were observed. Conclusions In conclusion, this case highlights the importance of maintaining a broad differential diagnosis when encountering rapidly progressing lower limb paralysis, especially in patients with vascular risk factors. Timely diagnosis and intervention in patients with acute limb ischemia can significantly impact patient outcomes. A multidisciplinary approach involving vascular surgeons, interventional radiologists, critical care specialists, and neurologists is crucial for optimizing patient outcomes in complex scenarios.