# Limb Salvage Surgery for Ponatinib-Induced Bilateral Chronic Limb-Threatening Ischemia in a Patient with Chronic Myeloid Leukemia with T315I Mutation in BCR-ABL: A Case Report

## TL;DR

A 72-year-old woman with chronic myeloid leukemia developed severe leg ischemia from ponatinib and required limb salvage surgery.

## Contribution

This case highlights the rare but severe vascular side effect of ponatinib and successful multidisciplinary limb salvage.

## Key findings

- Ponatinib caused bilateral chronic limb-threatening ischemia requiring amputation and surgical intervention.
- Multidisciplinary treatment, including foot bypass and wound care, led to successful epithelialization in one month.
- The case underscores the need for careful monitoring of vascular complications during ponatinib therapy.

## Abstract

A 72-year-old woman with chronic myeloid leukemia with T315I mutation in breakpoint cluster region-abelson (BCR-ABL) was treated with ponatinib. During the course of her treatment, chronic limb-threatening ischemia developed in both lower extremities, and the left lower extremity was amputated below the knee at a previous hospital. She was referred to our department for salvage of the right lower extremity. We performed a foot bypass and multidisciplinary treatment of the wound, and achieved epithelialization in about 1 month. The rate of vascular occlusive events with ponatinib has been reported to be high, and we believe that careful monitoring is important during use.