One of the most urgent vascular circumstances: Acute limb ischemia

Abstract

Acute limb ischemia is a sudden decrease in limb perfusion that threatens limb viability and requires urgent evaluation and management. Most of the causes of acute limb ischemia are thrombosis of a limb artery or bypass graft, embolism from the heart or a disease artery, dissection, and trauma. Assessment determines whether the limb is viable or irreversibly damaged. Prompt diagnosis and revascularization by means of catheter-based thrombolysis or thrombectomy and by surgery reduce the risk of limb loss and mortality. Amputation is performed in patients with irreversible damage. Despite urgent revascularization, amputation rate is 10%–15% in patients during hospitalization, mostly above the knee, and mortality within 1 year is 10%–15% due to the coexisting conditions.

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

“…ALI is characterised by a sudden decrease in arterial perfusion of the limb, with a potential threat to the survival of the limb, requiring urgent evaluation and management. 1 ALI is considered when the symptom duration is less than two weeks. 2,3 A symptom duration of greater than two weeks is usually considered to represent chronic limb ischaemia and is covered by other guidelines.…”

Acute Limb Ischemia: An Update on Diagnosis and Management

“…Acute arterial occlusion leads to intense vascular spasm and the limb will appear “marble” white. Over the next hours, the vessels relax, and the skin fills with deoxygenated blood, leading to a mottled aspect that blanches on pressure [13].…”

Acute Lower Limb Ischemia—Etiology, Pathology, and Management

“…After removal of the clot, intraoperative angiography is performed to confirm that the thrombectomy is complete and to guide subsequent treatment if there is persistent inflow or outflow obstruction. 19 If thrombectomy is not successful or if there is residual significant disease, then a bypass grafting or adjuncts, such as endarterectomy, patch angioplasty, and intraoperative thrombolysis, may become necessary. The surgical approach is also preferred in patients with ischemic symptoms for over 2 weeks.…”