Visual Summary.

Timeline of the Case

Timeline	Events	Take Home Points
Day 1	65-year-old man evaluated for Rutherford class 4 ischemic rest pain of the legs (L>R) chest pain and dyspnea
Day 2	Evaluation revealed abnormal ankle brachial indices of 0.5 (L) and 0.7 (R). Doppler USS showed monophasic waveforms and elevated velocities.
Day 4	Coronary and peripheral angiography performed revealing CAD and significant left common iliac artery disease. Coronary stenting was performed, and endovascular revascularization of left CIA staged.
Day 11	Left CIA stenting performed	IVUS should have been used pre and post intervention for proper vessel and stent sizing as well confirmation of stent mal apposition after deployment. This was however unavailable at time of procedure
Day 18	Patient complained of worsening rest pain symptoms of the left leg.	Prompt recognition of possible complication due to worsening symptoms post procedure helped diagnose problem and enable prompt management.
Day 19	Repeat angiogram showed migrated stent across aortic bifurcation. Stent repositioned and walled off with a balloon expandable stent	Highlights importance of procedural adaptability to ensure optimal outcomes.
Day 26	Follow-up at 14 d showed improved symptoms.	Crucial follow-up important to ensure resolution of symptoms.

CAD = coronary artery disease; CIA = common iliac artery; IVUS = intravascular ultrasound; USS = ultrasound scan.