ICU · Resuscitation

Acute limb ischaemia: embolic vs thrombotic, and emergency management

Also known as Acute limb ischaemia · ALI · Acute arterial occlusion · Limb-threatening ischaemia · Fogarty embolectomy

Acute limb ischaemia (ALI) = sudden decrease in limb perfusion (<14 days, the trial cutoff) threatening viability. CAUSES: (1) EMBOLIC — commonly cardiac (AF is the leading source; found in 60-95% of operated ALI series) or artery-to-artery (atheroembolism). Sudden, no collaterals, severe. (2) THROMBOTIC — thrombosis on existing plaque (PAD, graft thrombosis). Gradual onset (may have collaterals), less severe initially. CLINICAL (6 Ps): Pain, Pallor, Pulselessness, Paraesthesia, Paralysis, Perishing cold. Delay to revascularisation risks irreversible tissue infarction and loss of limb salvage. DIAGNOSIS: clinical + Doppler (arterial and venous signals) + angiography/CTA (location/cause). MANAGEMENT: IMMEDIATE therapeutic-dose heparin (weight-based, APTT-guided; associated with better 30-day survival), analgesia, EMERGENCY revascularisation (embolectomy, thrombolysis, bypass). FASCIOTOMY for reperfusion compartment syndrome when the differential pressure (diastolic BP minus compartment pressure) falls under 30 mmHg. OUTCOMES: amputation-free survival ~72% vs ~75% at six months (urokinase vs surgery, TOPAS II); one-year all-cause death up to ~29% (comorbidity-driven); major haemorrhage 12.5% vs 5.5% (TOPAS II).

Checked against its sources on 2 Oct 2026