Acute Limb Ischemia

Abstract

Acute limb ischemia (ALI) is a rapid decrease in lower limb blood flow due to acute occlusion of peripheral artery or bypass graft, and in ALI not only limbs but also life prognosis will be poor unless quick and appropriate treatment is given. The etiology is broadly divided into embolism and thrombosis with various comorbidities. The symptoms of ALI are abrupt with pain, numbness, and coldness of lower limb, and paresthesia, contracture, and irreversible purpura will appear with the exacerbation of ischemia. Severity and treatment strategy should be determined based on physical findings and image findings. Considering life prognosis, limb amputation should be done without hesitation when the limb was diagnosed as irreversible. ALI can be treated by means of open surgical revascularization, endovascular, or hybrid approach with rapid systemic administration of heparin. In any cases, evaluating the lesions by intraoperative angiography and appropriate additional treatment are important. ALI is a serious disease requiring urgent treatment, and it is essential to promptly perform the best initial treatment that can be performed at each facility. (This is a translation of Jpn J Vasc Surg 2018; 27: 109–114.)

Successful limb salvage by endovascular treatment for critical limb ischemia subsequent to acute limb ischemia

“…The amputation rate of ALI patients is reportedly 10–30% at 30 days, and the life prognosis is also poor unless treated promptly and appropriately [3]. There are several treatment options such as surgical treatment (thrombectomy and bypass surgery), EVT (catheter-directed thrombolysis, percutaneous thrombus aspiration, crushing thrombi by balloon inflation and stent deployment) and hybrid treatment that combines both therapies [4]. Surgical treatment using the Fogarty catheter rather than EVT is preferable for removing massive thrombi in ALI cases.…”

Endovascular Strategies in the Management of Acute Limb Ischemia

“…Early operative intervention, however, result in considerable risk of perioperative mortality. Despite advances in resuscitative care, reports state mortality rates as high as 20% in patients undergoing operative revascularization for ALI [1,6,8,13]. Individuals who present with ALI comprise one of the sickest subgroups of patients that the vascular specialist is asked to treat.…”

“…Physiologically compromised state of ALI in addition to inherent comorbidities that precipitated the thrombotic event drive mortality. Subjecting these individuals to invasive surgical procedures without adequate preoperative stabilization and preparation in combination with general anesthesia result in high rate of perioperative cardiopulmonary complications often encountered [1,8,11,13]. Furthermore, traditional Fogarty balloon assisted thrombectomy may be incomplete in restoring limb perfusion and emergency lower extremity bypass for ALI has been shown to be associated with increased rates of serious in-hospital adverse events, major amputation rates and mortality [8].…”

“…1). Additionally, lytic therapy is often superior in restoring patency of outflow vessels often difficult to address with conventional open techniques [1,11,13,15]. In recent years, mechanical endovascular solutions have evolved for more rapid clearance of thrombus and emboli in severe ischemia that require expedient revascularization [15–18].…”

Waist Training Corset: An Unusual Cause of Acute Lower Limb Ischemia

“…Acute limb ischemia (ALI) refers to a rapid decrease in lower limb blood flow due to acute occlusion of a peripheral artery or bypass graft. Clinical events that cause ALI include acute thrombosis of a limb artery or bypass graft, embolism from the heart, or a diseased artery, dissection, and trauma (from the severing of an artery or thrombosis) [1][2]. There is, however, a growing list of uncommon causes of ALI, which include aortic intimal sarcoma [3], popliteal artery entrapment syndrome [4], and prolonged arterial vasospasm of multiple vessels in multiple extremities simultaneously [5].…”