# A rare case of spontaneous aortic thrombosis presenting with unilateral auto-Lisfranc joint amputation in a young adult: A case report

## TL;DR

A young adult experienced rare aortic thrombosis leading to auto-Lisfranc amputation, highlighting the need for early diagnosis and treatment.

## Contribution

This case report presents an exceptionally rare presentation of aortic thrombosis with unilateral auto-Lisfranc amputation in a young adult.

## Key findings

- Spontaneous aortic thrombosis can rapidly progress to critical limb ischemia in young adults.
- Unilateral auto-Lisfranc joint amputation is an extremely rare initial symptom of aortic thrombosis.
- Surgical revascularization, such as aorto-bifemoral bypass, can improve outcomes in such cases.

## Abstract

Spontaneous aortic thrombosis is a rare clinical entity in young adults. Its rapid progression from intermittent claudication to critical limb ischemia presents significant diagnostic and therapeutic challenges. Early recognition and timely intervention are crucial to prevent severe complications. We report a rare case of spontaneous aortic thrombosis that presented with unilateral auto-Lisfranc joint amputation in a young adult.

A 22-year-old male presented with progressive intermittent claudication lasting five months, and a week's history of dark skin discoloration in both feet, leading to a left auto-Lisfranc joint amputation. Imaging studies revealed severe abdominal aortic thrombosis with absent blood flow to the lower extremities. Following this, an aorto-bifemoral bypass procedure was performed, resulting in an improved condition during discharge.

This case underscores the atypical presentation of primary aortic thrombosis in a young adult with no identifiable risk factors. The striking occurrence of unilateral auto-Lisfranc joint amputation as the initial symptom is exceptionally rare. Imaging revealed extensive aortic thrombus without indications of vasculitis or an embolic source, thereby necessitating surgical revascularization.

Early diagnosis and prompt intervention are crucial in preventing severe morbidity and limb loss related to acute limb ischemia. This case exemplifies the necessity for healthcare professionals to maintain heightened awareness of vascular diseases, particularly in young adults, and to act decisively to ensure optimal patient outcomes. Continuous follow-up, education on identifying symptoms of thromboembolism, and strict adherence to anticoagulation therapy are essential components in improving long-term prognosis and preventing recurrence.

•A high index of suspicion is needed to diagnose arterial thrombosis in young adult.•The rapidly progressing acute limb ischemia resulting in Auto Lisfranc amputation underscores the dangers of delayed diagnosis.•Early detection and surgical intervention of arterial thrombosis can prevent limb loss.•Thrombectomy and vascular bypass grafts are the options for the management of arterial thrombosis to salvage a limb.

A high index of suspicion is needed to diagnose arterial thrombosis in young adult.

The rapidly progressing acute limb ischemia resulting in Auto Lisfranc amputation underscores the dangers of delayed diagnosis.

Early detection and surgical intervention of arterial thrombosis can prevent limb loss.

Thrombectomy and vascular bypass grafts are the options for the management of arterial thrombosis to salvage a limb.