Objective:

To report a case of bilateral acute limb ischemia caused by an aortic saddle embolism and the management using percutaneous revascularization techniques, highlighting the clinical significance of timely intervention.

Approach:

• Case Presentation: A 40-year-old woman presented with severe pain and numbness in both legs, along with a bluish tinge in her toes. She was diagnosed with atrial fibrillation and severe mitral stenosis, and underwent percutaneous angiography which revealed total occlusion at the distal abdominal aorta.
• Intervention: Percutaneous mechanical thrombectomy and thromboaspiration were performed, successfully restoring blood flow to both lower extremities.
• Follow-Up: The patient received heparin therapy and underwent a second thromboaspiration with balloon angioplasty, resulting in normal blood flow in both lower extremities.

Key Findings:

• The patient presented with bilateral acute limb ischemia due to aortic saddle embolism.
• Percutaneous mechanical thrombectomy successfully restored blood flow to both lower extremities.
• The patient experienced no significant complications and fully recovered, with normal arterial and venous flow confirmed by duplex ultrasound.

Interpretation:

A modified wall-suction thromboaspiration may be a feasible option for managing bilateral acute limb ischemia due to aortic saddle embolism when dedicated devices are unavailable.

Limitations:

• The safety and reproducibility of the modified wall-suction thromboaspiration require further evaluation, particularly regarding potential complications and long-term outcomes.

Conclusion:

The case illustrates the effectiveness of percutaneous revascularization techniques in managing acute limb ischemia due to aortic saddle embolism.