Diagnosis and Treatment of Acute Limb Ischemia

Acute limb ischemia (ALI) occurs when perfusion to an extremity is abruptly obstructed, most commonly by either thrombus or emboli. Lack of arterial blood flow leads to oxygen depletion, nerve damage and eventual tissue death. Recognizing the signs and symptoms of ALI in conjunction with utilizing the Rutherford classification can aid in the swift diagnosis. Computed tomography angiography (CTA) is widely used to make the diagnosis of ALI. Upon diagnosis, initiation of unfractionated heparin is imperative to reduce the risk of clot propagation, as well as coordinating emergent intervention. Systematic reviews have shown catheter-directed thrombolysis (CDT) and open surgical intervention have similar rates of amputation, 12-month mortality, and recurrent ischemia. CDT is a less invasive method of treating ALI, but does have serious complications and takes time to complete. Open surgical intervention can often treat ALI quickly, but carries inherent risks as well