Large-vessel arterial thromboembolism is a rare initial presentation of acute myelogenous leukemia (AML). Aortoiliac occlusion is exceptionally uncommon and has not been previously reported in association with acute myelomonocytic leukemia (AML-M4).

We present the first documented case of a 55-year-old female with AML-M4 who initially presented with recurrent respiratory infections and acute left leg ischemia, which responded to intravenous heparinization and femoropopliteal thromboembolectomy. However, progressive bilateral lower extremity ischemia revealed extensive thromboembolism involving the aortoiliac and bilateral femoropopliteal regions, requiring repeat thromboembolectomy and retrograde kissing balloon aortic angioplasty. Flow cytometry confirmed AML-M4 with CD13, CD33, CD11C and myeloperoxidase positivity. Her condition deteriorated due to multiple acute cerebrovascular infarcts, acute coronary thrombosis and sepsis, leading to her demise.

A literature search of PubMed and Google Scholar (1980–2025) identified 51 cases of arterial thrombosis in AML.

Most patients were male (66%), with lower limb vessels (44%) as the most frequently affected sites. Acute promyelocytic leukemia (AML-M3) was the most common subtype. Management varied, including chemotherapy, anticoagulation and surgical or endovascular interventions.

The management of arterial thrombosis in AML is complex due to the competing risks of thrombosis, hemorrhage and infection. Early leukemia identification and timely chemotherapy initiation must be carefully balanced against the risks of cytopenias and immunosuppression in these critically ill patients.