Arterial Calcification Due to CD73 Deficiency (ACDC) Presenting With Critical Limb-Threatening Ischemia Successfully Treated With Iliac Endarterectomy and Distal Bypass

Abstract Arterial calcification due to CD73 deficiency (ACDC) is a rare disorder causing progressive medial calcification. Revascularization reports remain scarce. We describe a 67-year-old woman with ACDC and critical limb-threatening ischemia. Since endovascular therapy was unfeasible due to extensive calcification, we performed external iliac artery endarterectomy and anterior tibial artery bypass. Despite near-complete medial calcification, the adventitia allowed secure anastomosis. Postoperative imaging confirmed graft patency, and improved perfusion facilitated forefoot healing. Surgical reconstruction offers a viable option for limb salvage when endovascular therapy is precluded.