Patent Foramen Ovale Secondary to a Paradoxical Embolism Leading to Acute Limb Ischemia: A Case Report and Brief Review of Literature.

Acute limb ischemia, or ALI, is a rapid decrease in limb perfusion due to an occlusion of an artery or a bypass graft. Most cases result from in situ thrombosis or embolism in patients with antecedent peripheral arterial disease. Potential sources of arterial embolism as a cause of this condition include cardiogenic, aortic, peripheral aneurysms with an associated mural thrombus or, less commonly, a paradoxical embolism through a septal defect. We present a rare case of ALI due to an underlying patent foramen ovale that was successfully treated following revascularization. This article emphasizes one of the more unusual mechanisms of ALI. Despite the rarity, physicians should maintain a high index of clinical suspicion for a paradoxical embolism across a patent foramen ovale in unexplained arterial occlusion. Correct mechanism identification ensures adequate referral and prompt treatment that may reduce complications.