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

Background: Pregnancy is a well-recognized hypercoagulable state that increases the risk of thrombotic complications, most commonly venous thromboembolism. In contrast, arterial thrombosis, including acute limb ischemia (ALI), is exceedingly rare but potentially catastrophic, and no specific recommendations address its management during pregnancy. Methods: We report the clinical presentation of a pregnant woman who developed ALI during early gestation, along with a narrative review of the available literature. Results: Available evidence on ALI during pregnancy is limited to isolated case reports, predominantly occurring in late gestation or postpartum, with only two cases described in the first or second trimester, both related to popliteal artery entrapment. Cardioembolic events secondary to peripartum cardiomyopathy, often associated with preeclampsia, represent the most frequently reported etiology, whereas in situ arterial thrombosis is uncommon and typically occurs in the presence of thrombophilia or autoimmune disease. We report the first documented case of ALI in early pregnancy occurring in the absence of structural vascular abnormalities, thrombophilic disorders or identifiable cardioembolic triggers, despite the presence of multiple clinical cardiovascular risk factors. The clinical course was further complicated by preeclampsia and postpartum hemorrhage. Conclusions: This case suggests that pregnancy-related prothrombotic changes may contribute to acute arterial thrombosis even in early gestation in the presence of an increased burden of clinical risk factors. We highlight the importance of comprehensive thrombotic risk stratification and the development of evidence-based management strategies for pregnancy-associated arterial thrombosis.