Acute limb ischaemia

Specialty of Vascular surgery

What is acute limb ischemia?

Acute limb ischemia is the sudden lack of blood flow (and hence oxygen) to a limb due to either a blood clot (thrombosis) or embolism (a blockage of a vein caused by a foreign object). These can occur in patients of all ages. This is a serious condition and can result in tissue damage and potentially the loss of limbs.

What are the symptoms of acute limb ischemia?

The main symptoms of acute limb ischemia are known as ‘the six P’s’ and include:

  • Pain (ranging from burning or cramping in the muscles to severe pain)
  • Pulselessness (a loss of pulses in the affected limb)
  • Pallor (the skin in the affected limb becomes very pale)
  • Perishingly cold (coldness of the limb)
  • Paresthesias (prickling, numbing sensation)
  • Paralysis (inability to move the affected limb)

In later stages of acute limb ischemia, gangrene can manifest.

What causes acute limb ischemia?

The three main causes of acute limb ischemia are acute arterial thrombosis (blood clots), embolism and arterial trauma. There are also certain risk factors of ischemia:

  • Atherosclerosis (a build-up of plaque in the arteries)
  • Smoking
  • Older age
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Family history of cardiovascular disease
  • Obesity
  • Sedentary lifestyle

Can acute limb ischemia be prevented?

The most promising preventative measures are controlling the above risk factors by:

  • Stopping smoking
  • Controlling cholesterol
  • Controlling blood pressure
  • Eating a healthy diet
  • Losing weight (if you are overweight)
  • Managing diabetes
  • Exercising regularly

How is acute limb ischemia treated?

Treatment of acute limb ischemia will depend on the diagnostic test and scan results and where the ischemia is located. Treatment is either with medication or surgery. Medications such as anti-coagulants and clot-dissolving drugs can be used if the clot has been caused by a blood-clot (rather than a foreign object). A surgical procedure called an embolectomy can be carried out to remove the clot from the blood vessel. Severe blockages in the carotid arteries (near the heart) will sometimes require bypass surgery or a carotid endarterectomy which removes the plague build-up in the affected arteries.

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