Acute Limb Ischemia

Acute limb ischemia (ALI) is a vascular emergency caused by the sudden loss of arterial perfusion, most commonly due to arterial thrombosis and cardiac emboli. The typical signs and symptoms of ALI are referred to as the “6 Ps”: pain, pallor, pulselessness, paralysis, paresthesia, and poikilothermia of the limb distal to the site of vascular occlusion. Prompt diagnosis based on physical examination and bedside Doppler studies is crucial to prevent loss of the limb. Imaging studies (e.g., CTA) may be obtained but should not delay urgent restoration of perfusion. Systemic anticoagulation with heparin is recommended for most patients. Definitive treatment depends on clinical presentation and limb viability. Options include endovascular or surgical revascularization for viable or threatened limbs and amputation for nonviable limbs.