[Acute limb ischemia].

Abstract

PATHOPHYSIOLOGY: Signs and symptoms of acute limb ischemia follow the pathophysiology of the disease. If embolism--mainly of cardiac origin--hits a previously unaffected vessel, and if the same embolus occludes the anatomically preexisting collateral vessel, complete ischemia will occur. TREATMENT: Only a revascularization procedure without any delay will be able to avert major amputation; however, once the ischemia/reperfusion cascade has been started, the limb is threatened even after successful revascularization. If acute ischemia results from local arterial thrombosis in an atherosclerotic vessel system a sufficient number of collateral vessels may be recruited within a short time period; thus, borderline compensation of the perfusion is achieved in most cases. This situation allows for thorough angiographic evaluation of the whole arterial tree of the affected limb as well as for perioperative risk assessment of the patient. These are the prerequisites for a technically ambitious revascularization procedure which is needed in most of the older patients with significant comorbidity.