Acute Limb Ischemia During Pregnancy: A Case Report and Narrative Review of the Literature

Figures

• 

  Figure 1. Computed Tomography Angiography performed in the reported case. The arrows indicate intraluminal filling defects in the arteries of the left lower limb on arterial-phase contrast-enhanced Computed Tomography Angiography. In panels (A–C), the axial image is shown on the right and the corresponding coronal reconstruction on the left; the horizontal blue line in the coronal images indicates the level of the corresponding axial sections. Patient orientation is indicated by R (right), I (inferior), and P (posterior). (A) Partial thrombotic occlusion of the left common femoral artery. (B) Patency of the proximal left deep femoral artery, with occlusion of the left superficial femoral artery. (C) Occlusion of the mid segment of the left deep femoral artery, with persistent occlusion of the left superficial femoral artery.

• 

  Figure 2. Pathophysiological mechanisms and underlying conditions associated with acute limb ischemia in pregnancy and in the general population. As shown in the central panel, vascular thrombosis is classically explained by Virchow’s triad. Pregnancy ((Left) panel, red) is characterized by increased coagulation factors, venous stasis related to uterine compression of the iliac veins, and endothelial dysfunction, which may be further enhanced by preeclampsia or cesarean delivery. In contrast, in the general population ((Right) panel, blue), arterial thrombosis is predominantly associated with endothelial injury following atherosclerotic plaque disruption. Embolic acute limb ischemia is most commonly of cardiac origin, primarily related to atrial fibrillation in the general population and to peripartum cardiomyopathy during pregnancy.

• 

  Figure 3. Proposed multidisciplinary management framework for acute limb ischemia during pregnancy. The proposed flowchart summarizes a multidisciplinary approach to the prevention, diagnosis, acute management, and longitudinal follow-up of acute limb ischemia during pregnancy. Given the absence of dedicated guidelines for acute limb ischemia during pregnancy, the proposed framework integrates recommendations for acute limb ischemia in the general population with pregnancy-specific considerations regarding antithrombotic therapy, maternal and fetal surveillance, delivery planning, and postpartum follow-up. Abbreviations: ALARA, as low as reasonably achievable; ALI, acute limb ischemia; APS, antiphospholipid syndrome; BP, blood pressure; CTA, computed tomography angiography; DUS, duplex ultrasound; ECG, electrocardiography; LMWH, low-molecular-weight heparin; PAD, peripheral artery disease; PE, preeclampsia; PPCM, peripartum cardiomyopathy; TCD, transcranial doppler; UFH, unfractionated heparin.