Endovascular and Thrombolytic Therapy for Upper and Lower Extremity Acute Limb Ischemia

Abstract

This chapter focuses on the endovascular treatment options for acute limb ischemia (ALI) of the upper and lower extremities, namely, endovascular and thrombolytic therapies. ALI is associated with a high risk of loss of limb and life and thus requires prompt diagnosis. ALI is defined as a vascular emergency characterized by an abrupt loss of limb perfusion that threatens tissue viability presenting within 14 days of symptom onset. More than 200,000 patients suffered from lower extremity ALI in the USA in 2000. Estimated hospital mortality was 10 % and >1 in eight underwent in-hospital amputation. There are four clinical categories of ALI, which include limbs that are viable, marginally threatened, immediately threatened, and irreversibly damaged. Rutherford proposed an algorithm for ALI; after history and physical, Doppler examination confirmation of the diagnosis of ALI, heparin should be initiated. ALI Rutherford category I (if early intervention is appropriate) and IIA patients should proceed to angiography. These patients may undergo catheter-directed thrombolysis (CDT) with or without mechanical thrombectomy or surgical thrombo-embolectomy. For Rutherford category IIB patients, one must consider emergent surgery and late category III, delayed amputation.