Algorithmic Approach to the Acute Cold Leg

Abstract

Emergent surgical consultation may be requested for the evaluation of the cold lower extremity. Timely recognition, diagnosis, and intervention are crucial for successful limb salvage. Permanent tissue damage can occur in approximately 6 h in the completely ischemic limb. Etiologies of ischemia include: embolism from a proximal source, such as intracardiac thrombus in the patient with arrhythmia; acute thrombosis of chronic, localized disease; arterial dissection; occlusion of preexisting bypass graft; and thrombosis due to hypercoagulable state. Although various etiologies may be responsible, the underlying tenets of diagnosis and treatment are constant.