Abstract
Acute limb ischemia (ALI) is a vascular emergency associated with a high risk for
limb loss and death. Most cases result from in situ thrombosis in patients with preexisting
peripheral arterial disease or those who have undergone vascular procedures including
stenting and bypass grafts. The other common source is cardioembolic. The incidence
has decreased in recent times due to better anticoagulation strategies. Patients with
suspected ALI should be evaluated promptly by a vascular specialist and consideration
should be given for transfer to a higher level of care if such expertise is not available
locally. Initial assessment should focus on staging severity of ischemic injury and
potential for limb salvage. Neurological deficits can occur early and are an important
poor prognostic sign. Duplex ultrasound and computed tomography angiography help plan
intervention in patients with a still-viable limb and prompt catheter-based angiography
is mandated in patients with an immediately threatened limb. Further investigations
need to be pursued to differentiate embolic from thrombotic cause for acute occlusion
as this can change management. Options include intravascular interventions, surgical
bypass, or a hybrid approach. In this article, the authors discuss the common etiologies,
clinical evaluation, and management of patients presenting with acute limb ischemia.
Keywords
acute limb ischemia - limb viability - etiology - thromboembolism - thrombolysis -
thrombectomy - amputation.
