Acute and chronic lower limb ischaemia

Limb ischaemia is a common clinical condition that causes considerable morbidity and mortality and represents a major drain on healthcare resources. Peripheral arterial disease (PAD) is the leading cause of both acute and chronic limb ischaemia. Chronic limb ischaemia may also be caused by non-atherosclerotic processes such as arterial entrapment, fibrosis or arteritis. Acute limb ischaemia may be also due to embolism, thrombosis or trauma. Duplex ultrasonography, computed tomography angiography and magnetic resonance angiography are now conventional forms of arterial imaging, with catheter angiography reserved for intervention. Risk factor modification is extremely important for all these patients, since many will also have significant coronary or cerebrovascular disease. Those with claudication often improve with structured exercise and if symptoms progress they may benefit from angioplasty or stenting. Arterial bypass remains the mainstay of treatment for patients with critical limb ischaemia if they are fit enough for surgery. Acute limb ischaemia is a surgical emergency and can be treated with surgical embolectomy or catheter-directed thrombolysis (depending on local expertise). Patients with irreversible limb ischaemia should be treated with primary amputation or palliation as appropriate.