Surgical emergency: acute limb ischaemia
Ashok Handa, Kevin Turner, and Adam Jones examine a life threatening condition
A request to see a patient with a “cold limb” should be a priority as acute limb ischaemia has a high associated morbidity and mortality. Speed is important as complete acute limb ischaemia will lead to irreversible tissue damage within 6 hours unless the limb is revascularised.
In England and Wales approximately 5000 patients present each year with acute limb ischaemia, and the associated mor- tality is at least 20%, with a limb loss rate of 40%.1 Mortality is higher in patients presenting with embolic causes, while limb loss is higher in those with thrombosis. All patients presenting with an ischaemic limb should be assessed by an experienced surgeon. You should contact the surgical registrar as soon as you have seen the patient.
The classical description of the features of acute limb ischaemia is the “six Ps”: pain, parasthesia, paralysis, pallor, pulseless, and perishingly cold (Box 1). However, the severity