Acute Limb Ischemia

What Is Acute Limb Ischemia?

Acute Limb Ischemia (ALI) is a sudden decrease in blood flow to a limb, usually caused by a blocked artery, leading to severe pain, tissue damage, and potential limb loss if not treated quickly. Unlike chronic conditions that develop over time, ALI occurs suddenly and is considered a medical emergency that requires immediate intervention to restore circulation and prevent permanent damage.

ALI most commonly affects the legs, but it can also occur in the arms. Without prompt treatment, it can lead to gangrene and amputation.

Risk Factors

Several factors can increase the risk of developing Acute Limb Ischemia, including:

• Peripheral Artery Disease (PAD) – A major risk factor due to artery narrowing from plaque buildup.
• Atrial Fibrillation (AFib) and Heart Disease – Increases the risk of blood clots traveling to the limbs.
• Aneurysms and Arterial Dissections – Can cause sudden blockages in major arteries.
• Previous Stroke or Heart Attack – Indicates a higher likelihood of blood clot formation.
• Blood Clotting Disorders – Conditions that make the blood more likely to clot.
• Trauma or Injury – Severe vascular trauma or fractures can block blood.

Symptoms

The symptoms of Acute Limb Ischemia (ALI) develop suddenly and worsen quickly. Immediate medical attention is critical to prevent permanent tissue damage or limb loss. The classic signs of ALI are often referred to as the "6 Ps":

• Pain – Sudden, severe pain in the affected limb.
• Pallor – The limb appears pale due to lack of blood flow.
• Pulselessness – A weak or absent pulse in the limb.
• Paresthesia – Numbness, tingling, or a "pins and needles" sensation.
• Paralysis – Weakness or inability to move the limb.
• Poikilothermia – The affected limb feels cold compared to the rest of the body.

If left untreated, ALI can rapidly progress to tissue death (gangrene) and require amputation. Seek emergency care immediately if these symptoms occur.

Treatment

The goal of ALI treatment is to restore blood flow as quickly as possible to prevent permanent damage. The best approach depends on the severity of blockage, duration of symptoms, and overall health of the patient.

Emergency Medical Management

• Anticoagulant therapy (blood thinners) – Medications like heparin prevent clot growth and further blockages.
• Pain management – To relieve severe discomfort.
• Oxygen therapy and IV fluids – Supports circulation and overall vascular health.

Minimally Invasive Procedures

If the blockage is detected early, minimally invasive treatments may be used:

• Catheter-Directed Thrombolysis – A clot-dissolving drug (thrombolytic therapy) is delivered directly to the clot through a catheter.
• Thrombectomy – A specialized device is used to physically remove the clot from the artery.
• Angioplasty and Stenting – A balloon is used to open the artery, and a stent may be placed to keep it open.

Surgical Intervention

For severe cases, surgical procedures may be required:

• Emergency Bypass Surgery – A graft is used to reroute blood flow around the blockage.
• Open Embolectomy – A surgeon removes the clot directly from the artery.
• Fasciotomy – In cases of severe swelling, this procedure relieves pressure in the limb to prevent tissue damage.

AtlantiCare’s vascular specialists provide rapid, advanced treatment options to restore circulation, reduce complications, and save limbs whenever possible.