{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:44:15Z","timestamp":1777941855704,"version":"3.51.4"},"reference-count":10,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T00:00:00Z","timestamp":1750377600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Vasc Endovascular Surg"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:p>Background. Paradoxical embolism (PDE) through a patent foramen ovale (PFO) is a rare cause of acute limb ischemia (ALI). When surgical thrombectomy using a Fogarty catheter is not feasible, the DISASTER technique represents a viable and effective endovascular treatment strategy. Case report. A 51-year-old woman presented with the sudden onset of bilateral lower extremity pain and coldness. She had been receiving estrogen therapy for irregular menstruation. Angiography revealed a claw sign in the distal superficial femoral artery. She declined surgical thrombectomy due to concerns about invasiveness. Catheter-directed thrombectomy and thrombus aspiration were performed using the DISASTER (Diamond-Shaped wire Accelerate Splicing process of Thrombus used for Emergent Revascularization) technique. Ultrasound examination identified a thrombus distal to the left common femoral vein. Anticoagulation therapy with a direct oral anticoagulant (DOAC) was initiated. Comprehensive hematological testing revealed no evidence of an underlying coagulopathy. Additionally, no intracardiac thrombus or valvular vegetations were detected. Transesophageal echocardiography (TEE) identified a Grade 2 patent foramen ovale (PFO), suggesting paradoxical embolism as the likely etiology. The patient remained free of thromboembolic events postoperatively. Conclusion. This report highlights the feasibility of catheter-directed thrombectomy and thrombus aspiration as an effective alternative to surgical intervention for acute limb ischemia. In cases of ALI of unknown etiology, paradoxical embolism should be suspected. Therefore, a comprehensive evaluation, including venous ultrasound and transesophageal echocardiography, is essential to identify a potential PFO or other embolic sources. Early recognition and appropriate management of paradoxical embolism may help prevent recurrent thromboembolic events and improve patient outcomes.<\/jats:p>","DOI":"10.1177\/15385744251355186","type":"journal-article","created":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T07:47:34Z","timestamp":1750405654000},"page":"763-768","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Bilateral Acute Lower Limb Ischemia Caused by Paradoxical Embolism Through a Patent Foramen Ovale Treated With the DISASTER Technique: A Case Report"],"prefix":"10.1177","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1931-0236","authenticated-orcid":false,"given":"Eitaro","family":"Umehara","sequence":"first","affiliation":[{"name":"Department of Cardiology, Tsukazaki Hospital, Himeji, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yutaro","family":"Nagase","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tsukazaki Hospital, Himeji, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9357-4069","authenticated-orcid":false,"given":"Shunpei","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tsukazaki Hospital, Himeji, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsushi","family":"Miyajima","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tsukazaki Hospital, Himeji, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoto","family":"Inoue","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tsukazaki Hospital, Himeji, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arata","family":"Hagikura","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tsukazaki Hospital, Himeji, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takanori","family":"Kusuyama","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tsukazaki Hospital, Himeji, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,6,20]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2009.12.008"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa071422"},{"key":"e_1_3_6_4_2","first-page":"e726","article-title":"AHA\/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American college of cardiology\/American heart Association Task Force on clinical Practice guidelines","volume":"135","author":"Gerhard-Herman MD","year":"2017","unstructured":"Gerhard-Herman MD, Gornik HL, Barrett C, et al. AHA\/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American college of cardiology\/American heart Association Task Force on clinical Practice guidelines. 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