A 42 year old man, diagnosed with rheumatic heart disease and mitral stenosis, presented to the emergency department with acute onset low abdominal pain, severe pain in both lower limbs with paraplegia. The pulses of his feet could not be felt on either side. CT angiogram revealed saddle thrombus at the aorto-iliac junction occluding both common iliac arteries. An intra-arterial thrombolysis was done which was followed by anticoagulation. Within few hours of the thrombolysis, his abdominal pain and pain in the lower limbs subsided and he regained full function of both lower limbs. Pulses in the right foot could be felt but the left posterior tibial pulse was still weak after the procedure. He went on to develop gangrene of the left 2nd and 3rd toes which were amputated later.
Key words: Acute, Aorto-iliac, Mitral stenosis, Thrombosis.