Saving limbs, saving lives: How advanced vascular team treated a rare case

G. Thulasikumar1, T. Rathnaganpati2

1Senior Consultant, Endovascular and Vascular Surgery, Kauvery Hospital, Vadapalani, Chennai

2Senior Resident, Vascular surgery, Kauvery Hospital, Vadapalani, Chennai

A Rare but Serious Condition

Most of us heard of aneurysmal disease, but few know about multiple aneurysms in pelvic and femoral arteries. These are balloon-like swellings in arteries that can burst or block blood supply, leading to loss of life, pain, gangrene, or even amputation.

The Case at Kauvery Hospital

A 28-year-old young woman came to Kauvery Hospital with severe pain and blackening of her toes. She had already undergone surgery elsewhere, but her problem persisted. Scans revealed something extremely rare – multiple aneurysms in the arteries of her pelvis and legs.

Why It Was Dangerous

If left untreated, these swollen arteries could rupture or block blood flow completely, risking her limb and life. Traditional surgery would have been very risky because of her other health conditions.

The Advanced Treatment

Our Vascular & Endovascular Surgery team chose a minimally invasive option. Using small tubes inserted through the blood vessels, we placed covered stents – special tubes that seal off the weak part of the artery while keeping blood flowing. This way, the aneurysms were treated without major surgery.

The Outcome

The procedure was successful. Her pain improved, blood flow was restored, and her limb was saved. She continues to be monitored by a multidisciplinary team.

Why This Matters

  • Peripheral aneurysms are rare but dangerous.
  • Early diagnosis and treatment can prevent limb loss.
  • Endovascular stent procedures offer safe, less invasive alternatives to open surgery.

Kauvery Hospital’s Message This case shows our commitment to advanced, patient-centered care. With cutting-edge vascular expertise, we ensure that even the rarest and most complex conditions can be treated successfully — right here in Chennai.

Case Presentation

A 28-year-old female presented with severe pain and blackish discoloration of the right forefoot, sparing the little toe, of one-month duration. She had a history of rheumatoid arthritis on long-term steroids and a previous femoral thrombectomy. Clinical examination revealed gangrene of four toes, right foot drop, and palpable femoral and distal pulses.

Imaging and Work-up

  • CTA: Multiple aneurysms – right internal iliac, right superficial femoral, and left SFA, along with intramuscular abscesses suggesting septic emboli.
  • 2D Echo/TEE: Severe mitral regurgitation due to mitral valve prolapse, chordal rupture (surgically repaired).
  • Neurology: Cavernous angioma (L frontal gyrus) with seizure disorder.
  • Hematology: Negative autoimmune thrombophilia; elevated homocysteine.
  • Cultures were negative, and infective endocarditis was ruled out.

Provisional Diagnosis: Multifocal peripheral arterial aneurysms (probable infectious arteritis/systemic vasculopathy), Rheumatoid arthritis, and Hyperhomocysteinemia.

Management

Given the multifocal aneurysms and comorbidities, endovascular repair was chosen over open surgery. Covered stents (Bentley) were deployed in the right internal iliac artery, right SFA, and left SFA. This approach:

  • Excluded aneurysmal segments, preventing rupture.
  • Preserved distal perfusion.
  • Avoided morbidity associated with open repair in anatomically challenging regions.

Pre op pictures

Fig (1): On admission

pre op

Fig (4): Peripheral aneurysm

Post op picture

Discussion

Mycotic or inflammatory aneurysms are rare but carry high risks. Literature supports endovascular repair as an effective, lower-morbidity alternative to open surgery, with technical success rates >95% and perioperative mortality <1%. However, durability concerns exist, particularly in high-mobility regions (SFA, CFA). Careful follow-up is essential to detect endoleak, restenosis, or graft infection.

Conclusion

This case illustrates the challenges and successful use of endovascular therapy in managing multiple peripheral aneurysms in a young patient with systemic comorbidities. A multidisciplinary approach was critical, involving vascular surgery, cardiology, neurology, hematology, and infectious disease teams.

Key Learning Point: Endovascular covered stents offer a safe, effective, and minimally invasive strategy for multifocal peripheral aneurysms, especially in high-risk patients.

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