Management of acute limb ischemia after glue embolization of endoleak following endovascular abdominal aortic aneurysm repair

We describe the case of a 73-year-old woman who developed a type II endoleak and subsequent aneurysm sac expansion following endovascular abdominal aortic aneurysm repair. The endoleak was treated with a translumbar direct sac puncture and injection with n-butyl-2-cyanoacrylate. During the injection procedure, glue embolized distally, lodging into the right popliteal, proximal anterior tibial, and tibioperoneal arteries, causing acute limb ischemia that led to an emergency embolectomy. The patient recovered well, and the postoperative course was unremarkable. Acute limb ischemia secondary to glue embolization during endoleak management is rare, with potentially catastrophic complications that require urgent operative repair.