Popliteal Artery Occlusion Due to Femur Exostosis in a Patient With Rheumatoid Arthritis: A Rare Cause of Chronic Limb-Threatening Ischemia

Bony exostoses, or osteochondromas, are benign bone tumors that usually develop at growth plates during the growth period. Large exostosis can compress nearby vascular structures, causing occlusion, perforation, or pseudoaneurysm. We report a case of a middle-aged woman with rheumatoid arthritis (RA) and atherosclerotic risk factors who had an unusual presentation of chronic limb-threatening ischemia (CLTI) of the left leg combined with a flare-up of RA. She was found to have an occluded left popliteal artery due to a large femur exostosis. An uncomplicated left femoral-to-popliteal bypass was performed using a reversed great saphenous vein without excision of exostosis. Her ischemic symptoms have been resolved during a 30-month follow-up period. A high index of suspicion is required in such a case to reach the correct diagnosis and prevent catastrophic limb loss.