Acute Limb Ischemia

Acute limb ischemia occurs when there is an abrupt interruption of blood flow to an extremity usually because of either embolic or thrombotic vascular occlusion. When profound ischemia ensues, this represents an emergency in which restoration of perfusion through early intervention can lead to limb salvage, whereas delay may result in significant morbidity, including limb loss and, potentially, death. Patients in whom urgent or semi-urgent surgical or endovascular revascularization is indicated may undergo catheter angiography unless there is a contraindication, such as profound critical limb ischemia, renal dysfunction, or contrast allergy. Alternative imaging modalities include ultrasound, contrast-enhanced computed tomographic angiography, and magnetic resonance angiography. The clinical degree of the ischemic insult will determine the most appropriate course of management, as severely ischemic limbs may require immediate surgical revascularization, while endovascular interventions, such as catheter-directed thrombolysis, may be appropriate in patients with moderate ischemia. Additionally, many percutaneous mechanical thrombectomy devices are being used or undergoing clinical evaluation, either alone or in combination with pharmacologic thrombolysis, for the treatment of acute limb-threatening ischemia. In this article, we present our approach to an acutely ischemic limb, with a focus on the pertinent aspects of endovascular intervention.