Background and Objectives Epidural hematoma is a severe, uncommon complication associated with epidural anesthesia in patients with peripheral vascular disease who require anticoagulant therapy.

Methods An 84-year-old woman with acute left leg arterial ischemia underwent revascularization surgery under lumbar epidural anesthesia. Pre- and postoperative heparin was administered as an anticoagulant.

Results Reperfusion of the leg was successful, however, 3 days later clinical signs of spinal cord compression appeared and epidural hematoma was diagnosed. Neurologic recovery was poor.

Conclusions This case highlights the need for careful individual preoperative analysis and postoperative observation to make anesthetic practice safe in patients receiving perioperative anticoagulant therapy.