Spontaneous sub-amputation from atypical critical limb ischemia in a patient without classical risk factors

Background

Spontaneous sub-amputation is a rare manifestation of critical limb ischemia (CLI), most often associated with advanced vascular disease and comorbidities. We present a case of spontaneous foot sub-amputation in an elderly patient without major lifestyle-related risk factors, managed in a resource-limited setting.

Case Report

A 76-year-old male with no history of diabetes, hypertension, or smoking presented after his left foot detached spontaneously during sleep, following two months of leg pain and two days of worsening discoloration and fever. On examination, he was septic, with absent left femoral and popliteal pulses and advanced gangrene. Imaging was not performed due to systemic and facility constraints. Emergency above-knee amputation was performed. Intraoperatively, thrombus removal was achieved using a Foley catheter in place of a Fogarty catheter. Postoperatively, the patient stabilized and showed good wound healing. Further diagnostics, including histopathology and thrombophilia screening, were not feasible due to financial and systemic limitations.

Discussion

This case highlights an atypical CLI presentation in a patient without conventional lifestyle-associated risk factors, but with overlooked contributors such as prediabetes. The absence of imaging and vascular tools required improvisation for timely limb removal. The use of a Foley catheter for thrombectomy demonstrates adaptable practice in low-resource environments. Although the underlying etiology could not be fully confirmed, acute-on-chronic arterial occlusion was the most plausible diagnosis.

Conclusion

Early recognition, sound clinical judgment, and surgical adaptability are vital in underserved settings. This case demonstrates that even with limited diagnostics and resources, effective outcomes can still be achieved.