Acute Limb Ischemia
N Engl J Med 2012;366:2198-206
- Weakness or paralysis
- Absent pulses
- Cool skin
- Decreased sensation
- Decreased strength
- Limb blood pressure
- Thrombosis of artery or bypass graft
- Embolism from heart or proximal vessel
Stages of Acute Limb Ischemia
- 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.