Skip to main content

Acute Limb Ischemia

  • Chapter
  • First Online:
Vascular Diseases for the Non-Specialist

Abstract

Acute ischemia is the sudden reduction of limb perfusion due to acute interruption of blood flow, endangering its viability. It may be secondary to an embolic event or arterial thrombosis, each with its own distinct characteristics and prognosis. The symptoms are known as the six P’s: Pain, Pallor, Paresthesia, Paralysis, Pulseless, and Poikilothermia. Time of ischemia defines the prognosis. Treatment requires an expert since it involves urgent revascularization surgery in many cases. The degree and time of ischemia helps determine the best choice of treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45 Suppl S:S5–67.

    Google Scholar 

  2. Walker TG. Acute limb ischemia. Tech Vasc Interv Radiol. 2009;12(2):117–29.

    Article  PubMed  Google Scholar 

  3. Berridge DC, Kessel D, Robertson I. Surgery versus thrombolysis for acute limb ischaemia: initial management. Cochrane Database Syst Rev. 2002;(3):CD002784.

    Google Scholar 

  4. Graor R, Comerota A, Douville Y, Turpie A, Froehlich J, Hosking J, et al. Results of a prospective randomized trial evaluating surgery versus thrombolysis for ischemia of the lower-extremity-the stile trial. Ann Surg. 1994;220(3):251–68.

    Article  Google Scholar 

  5. Mutirangura P, Ruangsetakit C, Wongwanit C, Sermsathanasawadi N, Chinsakchai K. Clinical differentiation between acute arterial embolism and acute arterial thrombosis of the lower extremities. J Med Assoc Thai. 2009;92(7):891–7.

    PubMed  Google Scholar 

  6. O’Donnell TF. Arterial diagnosis and management of acute thrombosis of the lower extremity. Can J Surg. 1993;36(4):349–53.

    PubMed  Google Scholar 

  7. Lyaker MR, Tulman DB, Dimitrova GT, Pin RH, Papadimos TJ. Arterial embolism. Int J Crit Illn Inj Sci. 2013;3(1):77–87.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Saric M, Kronzon I. Aortic atherosclerosis and embolic events. Curr Cardiol Rep. 2012;14(3):342–9.

    Article  PubMed  Google Scholar 

  9. Dag O, Kaygın MA, Erkut B. Analysis of risk factors for amputation in 822 cases with acute arterial emboli. ScientificWorldJournal. 2012;2012:673483.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Wasilewska M, Gosk-Bierska I. Thromboembolism associated with atrial fibrillation as a cause of limb and organ ischemia. Adv Clin Exp Med. 2013;22(6):865–73.

    PubMed  Google Scholar 

  11. Campbell WB, Ridler BM, Szymanska TH. Two-year follow-up after acute thromboembolic limb ischaemia: the importance of anticoagulation. Eur J Vasc Endovasc Surg. 2000;19(2):169–73.

    Article  CAS  PubMed  Google Scholar 

  12. White DC, Grines CL, Grines LL, Marcovitz P, Messenger J, Schreiber T. Comparison of the usefulness of enoxaparin versus warfarin for prevention of left ventricular mural thrombus after anterior wall acute myocardial infarction. Am J Cardiol. 2015;115(9):1200–3.

    Article  CAS  PubMed  Google Scholar 

  13. Nunes MC, Kreuser LJ, Ribeiro AL, Sousa GR, Costa HS, Botoni FA, et al. Prevalence and risk factors of embolic cerebrovascular events associated with Chagas heart disease. Glob Heart. 2015;10(3):151–7.

    Article  PubMed  Google Scholar 

  14. Windecker S, Stortecky S, Meier B. Paradoxical embolism. J Am Coll Cardiol. 2014;64(4):403–15.

    Article  PubMed  Google Scholar 

  15. Sontheimer DL. Peripheral vascular disease: diagnosis and treatment. Am Fam Physician. 2006;73(11):1971–6.

    PubMed  Google Scholar 

  16. Alfirević Z, Alfirević I. Hypercoagulable state, pathophysiology, classification and epidemiology. Clin Chem Lab Med. 2010;48 Suppl 1:S15–26.

    PubMed  Google Scholar 

  17. Andersen LV, Lip GY, Lindholt JS, Frost L. Upper limb arterial thromboembolism: a systematic review on incidence, risk factors, and prognosis, including a meta-analysis of risk-modifying drugs. J Thromb Haemost. 2013;11(5):836–44.

    Article  CAS  PubMed  Google Scholar 

  18. O’Connell JB, Quiñones-Baldrich WJ. Proper evaluation and management of acute embolic versus thrombotic limb ischemia. Semin Vasc Surg. 2009;22(1):10–6.

    Article  PubMed  Google Scholar 

  19. Haigh KJ, Bingley J, Golledge J, Walker PJ. Barriers to screening and diagnosis of peripheral artery disease by general practitioners. Vasc Med. 2013;18(6):325–30.

    Article  PubMed  Google Scholar 

  20. Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997;26(3):517–38.

    Article  CAS  PubMed  Google Scholar 

  21. Eliason JL, Wakefield TW. Metabolic consequences of acute limb ischemia and their clinical implications. Semin Vasc Surg. 2009;22(1):29–33.

    Article  PubMed  Google Scholar 

  22. Lavanier GL, Sacks D, Robinson ML. Acute limb ischemia. Emerg Med Clin North Am. 1992;10(1):103–19.

    CAS  PubMed  Google Scholar 

  23. Hodgkiss-Harlow KD, Bandyk DF. Interpretation of arterial duplex testing of lower-extremity arteries and interventions. Semin Vasc Surg. 2013;26(2–3):95–104.

    Article  PubMed  Google Scholar 

  24. Schoder M. Acute peripheral arterial ischemia: diagnosis and interventional therapy. Wien Med Wochenschr. 2001;151(21–23):541–5.

    CAS  PubMed  Google Scholar 

  25. Zeboulon C, Amy de la Bretèque M, Bilan P, Sin C, Linder JF, Dakhil B, et al. [Phlegmasia cerulea dolens]. Ann Dermatol Venereol. 2014;141(11):682–4.

    Article  CAS  PubMed  Google Scholar 

  26. Ayarragaray JE. Ergotism: a change of perspective. Ann Vasc Surg. 2014;28(1):265–8.

    Article  PubMed  Google Scholar 

  27. Brand M, Woodiwiss AJ, Michel F, Nayler S, Veller MG, Norton GR. Large vessel adventitial vasculitis characterizes patients with critical lower limb ischemia with as compared to without human immunodeficiency virus infection. PLoS One. 2014;9(8):e106205.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Roca B, Roca M. The new oral anticoagulants: reasonable alternatives to warfarin. Cleve Clin J Med. 2015;82(12):847–54.

    PubMed  Google Scholar 

  29. Saarinen Anders Albäck E, Albäck A. [Lower limb pain of arterial origin]. Duodecim. 2013;129(17):1813–9.

    Google Scholar 

  30. Rutherford RB. Clinical staging of acute limb ischemia as the basis for choice of revascularization method: when and how to intervene. Semin Vasc Surg. 2009;22(1):5–9.

    Article  PubMed  Google Scholar 

  31. Ouriel K. Endovascular techniques in the treatment of acute limb ischemia: thrombolytic agents, trials, and percutaneous mechanical thrombectomy techniques. Semin Vasc Surg. 2003;16(4):270–9.

    Article  PubMed  Google Scholar 

  32. Ouriel K. Randomized comparison of thrombolysis and surgery. TOPAS investigators. Thrombolysis or peripheral arterial surgery. J Vasc Interv Radiol. 1995;6(6 Pt 2 Suppl):83S.

    Google Scholar 

  33. Giannini D, Balbarini A. Thrombolytic therapy in peripheral arterial disease. Curr Drug Targets Cardiovasc Haematol Disord. 2004;4(3):249–58.

    Article  CAS  PubMed  Google Scholar 

  34. Acosta S, Kuoppala M. Update on intra-arterial thrombolysis in patients with lower limb ischemia. J Cardiovasc Surg (Torino). 2015;56(2):317–24.

    CAS  Google Scholar 

  35. Ouriel K. Current status of thrombolysis for peripheral arterial occlusive disease. Ann Vasc Surg. 2002;16(6):797–804.

    Article  PubMed  Google Scholar 

  36. Baumann F, Sharpe E, Peña C, Samuels S, Benenati JF. Technical results of vacuum-assisted thrombectomy for arterial clot removal in patients with acute limb ischemia. J Vasc Interv Radiol. 2016;27(3):330–5.

    Article  PubMed  Google Scholar 

  37. Costantini V, Lenti M. Treatment of acute occlusion of peripheral arteries. Thromb Res. 2002;106(6):V285–94.

    Article  CAS  PubMed  Google Scholar 

  38. Ouriel K. Comparison of surgical and thrombolytic treatment of peripheral arterial disease. Rev Cardiovasc Med. 2002;3 Suppl 2:S7–16.

    PubMed  Google Scholar 

  39. Storck M, Wagner HJ. Peripheral arterial obstruction and acute lower limb ischemia. Chirurg. 2007;78(7):611–9.

    Article  CAS  PubMed  Google Scholar 

  40. Hu HD, Chang Q, Chen Z, Liu C, Ren YY, Cai YC, et al. Management and prognosis of acute arterial embolism: a multivariable analysis of 346 patients. Zhonghua Yi Xue Za Zhi. 2011;91(41):2923–6.

    PubMed  Google Scholar 

  41. de Donato G, Setacci F, Galzerano G, Borrelli MP, Mascolo V, Mazzitelli G, et al. Endovascular treatment of popliteal aneurysm. J Cardiovasc Surg (Torino). 2015;56(4):587–97.

    Google Scholar 

  42. Blaisdell FW. The reperfusion syndrome. Microcirc Endothelium Lymphatics. 1989;5(3–5):127–41.

    CAS  PubMed  Google Scholar 

  43. Trummer G, Brehm K, Siepe M, Heilmann C, Schlensak C, Beyersdorf F. The management of acute limb ischemia. Minerva Chir. 2010;65(3):319–28.

    CAS  PubMed  Google Scholar 

  44. Sellei RM, Hildebrand F, Pape HC. Acute extremity compartment syndrome: current concepts in diagnostics and therapy. Unfallchirurg. 2014;117(7):633–49.

    Article  CAS  PubMed  Google Scholar 

  45. Percival TJ, White JM, Ricci MA. Compartment syndrome in the setting of vascular injury. Perspect Vasc Surg Endovasc Ther. 2011;23(2):119–24.

    Article  PubMed  Google Scholar 

  46. Blaisdell FW. The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome: a review. Cardiovasc Surg. 2002;10(6):620–30.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Renata de Moura Vergara M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

de Moura Vergara, R., de Souza Pereira da Silva, M.C., Procópio, R.J., Mourão, M.S.F. (2017). Acute Limb Ischemia. In: Navarro, T., Dardik, A., Junqueira, D., Cisneros, L. (eds) Vascular Diseases for the Non-Specialist. Springer, Cham. https://doi.org/10.1007/978-3-319-46059-8_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-46059-8_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-46057-4

  • Online ISBN: 978-3-319-46059-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics