Endovascular rescue for adolescent acute limb ischemia after femoral limb lengthening

Acute limb ischemia (ALI) is rare in adolescents, and evidence-based guidance is limited. Limb-lengthening procedures can distort popliteal anatomy and may predispose delayed arterial complications. We report the case of a 17-year-old man with a history of femoral lengthening surgery presenting with Rutherford grade IIA ALI caused by popliteal artery thrombosis. Initial open revascularization was aborted secondary to displaced, abnormally cephalad anatomy preventing safe exposure of the below-the-knee popliteal artery. We describe successful revascularization after transitioning to an endovascular approach. Cardiac and hypercoagulable workup did not demonstrate a contributing cause to his ALI. The patient had a resolution of ischemic symptoms postoperatively. At the 1-month follow-up, the patient had normal ankle-brachial indices and no evidence of stenosis on duplex ultrasound examination. On subsequent surveillance, the covered stent developed a short-segment occlusion, and the patient is now planned for bypass. This case demonstrates a rare complication of limb-lengthening surgery and the distortion of infrageniculate anatomy with limb lengthening.