Acute limb ischaemia
How do you reach a diagnosis? Jignesh Tailor and colleagues help us to start thinking beyond the six Ps
Acute limb ischaemia is a limb and life threatening condition affecting over 5000 patients each year in England and Wales. The associated mortality is 20% with a limb loss rate of 40%. Nearly all medical students will see a patient with a “cold limb” either in the community or A&E department and others may witness the management of such patients on a vascular service. Junior doctors won't need to learn the operative steps of treating limb ischaemia, but you will be expected to assess the vascularity of a limb, resuscitate the patient, and understand the key factors that determine the subsequent steps in management.
Most limb ischaemia is chronicand ranges in severity from minimal (intermittent claudication) to critical (rest pain for more than two weeks, ulceration/gangrene or Doppler pressure <50 mm Hg).
Acute limb ischaemia occurs suddenly and often threatens the viability of the limb. The classic presentation of acute