Acute Limb Ischemia

Acute Limb Ischemia from Sun YaiCheng

Acute Limb Ischemia

N Engl J Med 2012;366:2198-206

Symptoms

• Pain
• Paresthesia
• Weakness or paralysis

Signs

• Absent pulses
• Pallor
• Cool skin
• Decreased sensation
• Decreased strength
• Limb blood pressure

Potential Causes

• Thrombosis of artery or bypass graft
• Embolism from heart or proximal vessel
• Dissection
• Trauma

Stages of Acute Limb Ischemia



Treatment

• Endovascular Revascularization
• Surgical Revascularization

• Catheter-directed thrombolysis has the best results in patients with a viable or marginally threatened limb, recent occlusion (no more than 2 weeks’ duration), thrombosis of a synthetic graft or an occluded stent, and at least one identifiable distal runoff vessel.
• Surgical revascularization is generally preferred for patients with an immediately threatened limb or with symptoms of occlusion for more than 2 weeks.

Algorithm for the Diagnosis and Treatment of Acute Limb Ischemia



Conclusions and Recommendations

• Heparin should be administered as soon as the diagnosis has been made. 

• In a patient with a viable or marginally threatened limb, imaging studies (duplex ultrasonography, CTA, or MRA) can be obtained to guide therapeutic decisions.

• In a patient with an immediately threatened limb, such as the patient described in the vignette, emergency angiography followed by catheter-based thrombolysis or thrombectomy or open surgical revascularization is indicated to restore blood flow and preserve limb viability.