Common Sites of Occlusion

This occurs at the sites of branching vessels:

• Aortic bifurcation.
  
• Common femoral artery.
  
• Below-knee trifurcation (not a true trifurcation!).

Symptoms and Signs

The salient feature of the acute limb is pain!

It can be difficult to decide between pain from an acute limb and pain from deteriorating PVD (see Table 37.1), but in general the acute limb will have:

• Short history
  
• Sudden presentation
  
• The 6 Ps of acute limb ischaemia (see Table 37.2).

Rest pain coupled with neurology (decreased sensation or motor function) mandates emergency treatment!

Complications of the Acute Limb

• Irreversible necrosis and gangrene (note: ‘ischaemic window’).
  
• Tissue loss and ulceration (especially digits).
  
• Ischaemic neuropathy (motor/sensory).
  
• Painful ischaemic neuritis.
  
• High rate of limb loss (amputation).
  
• Septicaemia and acute kidney injury (wet gangrene).

Ischaemic Window

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