Improvement of rest pain in a patient with symptomatic peripheral artery disease as an unexpected outcome of carotid endarterectomy: A case report

Background: Carotid endarterectomy (CEA) has proven efficacy in reducing the long-term risk of disabling strokes. However, it can also lead to unexpected benefits, such as improvement of neurological symptoms or arterial hypertension. In this case report we present a patient with peripheral arterial disease (PAD) who reported sudden relief of rest pain after bilateral CEA.
Case presentation: A 65-year-old Ukrainian male presented with 2 2-year history of intermittent claudication and rest pain in the left lower limb. On ultrasound asymptomatic critical stenosis of the left and right internal carotid arteries, and critical stenosis of the left iliac segment were revealed. After the first right-sided CEA on the first postoperative day, the patient suddenly reported relief of rest pain in the left lower limb. After the second left-sided CEA, the patient reported relief of a ``burning sensation`` and paresthesia of the left foot. The patient’s ankle-brachial index was the same before and after the operation.
Conclusion: Despite the well-known purpose of CEA rarely it can lead to unexpected satisfactory outcomes and improvement of patient quality of life. Improvement of lower extremity rest pain after CEA is rare but yet possible, although the explanation of this phenomenon needs further investigation.