From the Guidelines
The treatment for acute limb ischemia (ALI) is revascularization, which should be performed emergently for threatened limbs and urgently for viable limbs.
Revascularization Strategies
- Revascularization strategies include catheter-directed thrombolysis, surgical thromboembolectomy, and mechanical thrombectomy 1
- The choice of revascularization strategy depends on local resources, patient factors, and the etiology and degree of ischemia 1
- Catheter-based thrombolysis is effective for patients with ALI and a salvageable limb, with similar limb salvage rates to open surgery but higher rates of bleeding 1
Timing of Revascularization
- Revascularization should be performed within 6 hours for marginally or immediately threatened limbs (Category IIa and IIb ALI) and within 6-24 hours for viable limbs (Category I ALI) 1
- Prolonged duration of ischemia is the most common factor in patients requiring amputation for treatment of ALI, and patients with an insensate and immobile limb in the setting of prolonged ischemia (>6 to 8 hours) are unlikely to have potential for limb salvage 1
Additional Considerations
- Additional evaluation and consideration before revascularization may be warranted in patients with ALI associated with or induced by systemic proinflammatory and prothrombotic states 1
- Amputation should be performed as the first procedure in patients with a nonsalvageable limb 1
- The use of anticoagulation, prostanoids, and other medical therapies may be necessary to stabilize the ischemic status in cases where revascularization is not possible 1
From the Research
Treatment Options for Acute Limb Ischemia (ALI)
The treatment for acute limb ischemia (ALI) depends on the severity of the ischemic insult and the clinical degree of the ischemic insult [(2,3,4,5,6)]. The goal of treatment is to restore blood flow to the affected limb as quickly as possible to prevent irreversible damage.
Revascularization Techniques
Revascularization may be accomplished using:
- Open surgical revascularization [(4,5,6)]
- Endovascular techniques, such as catheter-directed thrombolysis, rheolytic thrombectomy, and utilization of distal protection devices [(2,3,4,6)]
- Hybrid techniques 5
- Percutaneous mechanical thrombectomy devices, either alone or in combination with pharmacologic thrombolysis [(2,6)]
Factors Influencing Treatment Choice
The choice of treatment depends on:
- Severity of ischemia [(2,5,6)]
- Location of occlusion 5
- Cause of occlusion 5
- Chance of recovery 5
- Comorbidities 5
- Available resources 5
- Anatomic location 6
- Etiology 6
- Local practice patterns 6
Importance of Prompt Treatment
Prompt treatment is crucial to prevent irreversible damage and limb loss [(2,3,4,5,6)]. Delay in diagnosis and therapy may lead to irreversible ischemic damage 6. Patients with acute limb ischemia should receive immediate anticoagulation 6.