Background: Essential Thrombocytosis is a rare chronic myeloproliferative disorder characterized by uninhibited platelet production and a significant risk of arterial thrombosis. When such patients present with thrombotic complications like limb ischemia, the clinical picture may closely resemble peripheral vascular disease. Case Report: An elderly woman presented with dry gangrene of amputated below-knee stump, treated as a case of Peripheral Vascular Disease previously. Her platelet counts were found to be persistently elevated. A retrospective review of previous laboratory records also revealed unexplained thrombocytosis which was overlooked or missed. A diagnosis of essential thrombocytosis was made by positive JAK2 V617F mutation. Hydroxyurea and anti platelet therapy, resulting in significant improvement. Discussion: It is essential to recognize Essential Thrombocytosis when presenting as a vascular mimic especially in elderly patients presenting with ischemia,without atherosclerotic risk factors. Early evaluation for myeloproliferative neoplasms through mutation analysis, enables timely cyto-reductive therapy and significantly reduces the risk of further ischemia.