Acute Limb Ischaemia

Acute limb ischaemia is a sudden loss of blood supply to an arm or a leg. It is a medical emergency: without prompt treatment, the muscles and nerves start to die within hours and the limb can be lost.

104 Acute Limb Ischaemia - Surgical and Endovascular Treatment

Causes

A clot from elsewhere (embolism) – most often from the heart, in people with an irregular heartbeat (atrial fibrillation) or after a heart attack, or from an aneurysm.
A clot forming in a narrowed artery (thrombosis) – in people who already have peripheral arterial disease.
A blocked bypass graft or stent.
A clot in an aneurysm behind the knee (popliteal aneurysm).
Injury to an artery, or a tear in the artery wall (dissection).

Tests

Diagnosis is made mainly by examination, including checking the pulses with a hand-held Doppler. If the limb is not in immediate danger, a CT angiogram or duplex ultrasound shows where the blockage is. Blood tests and a heart tracing (ECG) look for the cause. When the limb is in immediate danger, treatment is not delayed for scans.

Treatment

A blood thinner (heparin) is given straight away to stop the clot from growing. The blood supply is then restored as quickly as possible:

Embolectomy or thrombectomy – the clot is removed through a small incision, usually in the groin or behind the knee, with a balloon catheter.
Catheter-directed thrombolysis – a clot-dissolving drug is delivered through a thin tube placed in the clot; suitable when the limb is not in immediate danger.
Endovascular clot removal, angioplasty or stenting to treat the narrowing that caused the clot.
Bypass surgery when the artery cannot be cleared.
Fasciotomy – when the muscles swell after the blood supply returns (compartment syndrome), the tight tissue around them is opened to relieve the pressure.

If the limb has been without blood for too long and cannot be saved, an amputation may be needed to protect your life.

After treatment

Finding the cause matters. If the clot came from the heart, you will usually need long-term anticoagulation (a blood thinner) to prevent another one. If it came from a narrowed artery, the treatment and prevention of peripheral arterial disease apply.

Even with prompt treatment, acute limb ischaemia carries a real risk of amputation and of death, mainly because many patients also have serious heart disease. This is why speed matters so much.

Reference
Björck M, Earnshaw JJ, Acosta S, et al. European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia. Eur J Vasc Endovasc Surg 2020;59(2):173–218. doi:10.1016/j.ejvs.2019.09.006

Our Services

Emergency embolectomy and thrombectomy
Peripheral arterial catheter-directed thrombolysis
Angioplasty and stenting
Bypass surgery
Fasciotomy

See also: Peripheral Arterial Disease · Aortic Aneurysm

If you have any problems with any of these conditions, please contact your General Practitioner, or your Vascular Surgeon.