[7] With proper surgical care, acute limb ischaemia is a highly treatable condition; however, delayed treatment (beyond 6 to 12 hours) can result in permanent disability, amputation, and/or death.

Compartment syndrome is an occasional complication that may also occur in acute limb ischaemia because of the biotoxins that accumulate distal to the occlusion resulting in edema.

In late stages, paresthesia is replaced by anesthesia (numbness) due to death of nerve cells.

[2] Patients who have an embolic (small piece of debris that breaks off from somewhere else in the body, such as the heart) cause of ALI often present with unilateral decreased pulses, whereas those with a thrombotic (clot that forms directly in the blood vessel) cause of ALI such as atherosclerosis often present with bilateral decreased pulses.

[14] Thrombosis occurs when a blood clot forms within an artery, which can result from atherosclerosis or a hypercoagulable state.

[15] Common sources of emboli leading to arterial occlusions include thrombi from the heart or debris from the proximal aorta.

[15] Hard signs include pulsatile bleeding, expanding hematomas (collections of blood), or absent distal pulses, and must be taken to surgery emergently.

[15] Once signs and symptoms of acute limb ischemia are identified, the cause and location of the occlusion and its severity need to be addressed.

[1] A Doppler evaluation is often the first imaging choice to diagnose ALI because it is inexpensive, accessible, non-invasive, and can be done in a short amount of time.

[2] Although Doppler ultrasounds provide excellent information, there may be difficulty in evaluating aortic or iliac arteries in patients who are obese or have significant gas.

The CTA and MRA provide higher-resolution images used in planning revascularization, but they may only be used in patients without a threatened limb due to time constraints.

[19] The primary prevention of acute limb ischemia starts with awareness of peripheral artery disease (PAD).

[20] The VIVA trial demonstrated a 7% reduction in mortality of using ankle-brachial index (ABI), blood pressure management, and ultrasonography for vascular disease screening.

[11] Treatment depends on many factors, including: Endovascular interventions for ALI are minimally invasive procedures designed to quickly restore blood flow and avoid more extensive surgery.

Mechanical methods of injecting the thrombolytic compounds have improved with the introduction of pulsed spray catheters—which allow for a greater opportunity for patients to avoid surgery.

[14] Surgery is often recommended in those with Rutherford Class 2b or greater, as blood flow is generally restored much more quickly.