Acute Ischemic Limb

Acute ischemic limb develops when an arm or leg (limb) has trouble getting enough blood. This happens when an artery (a large blood vessel that carries oxygen and nutrients that feed your body) is partially or totally blocked. It is also called critical limb ischemia. The problem affects the legs more often than the arms. It is described as acute when the condition comes on suddenly. When this happens, it is considered a medical emergency.

CAUSES

An ischemic limb almost always is the result of underlying atherosclerotic disease (when artery walls become thick and hard). It develops because of the buildup of fatty material that hardens (plaque) in arteries and veins. This buildup narrows the blood vessels and keeps tissues in the limb from getting enough blood. Small amounts of plaque can break off from the walls of the blood vessels and create a clot. This blocks the blood flow and causes ischemic limb.

Other factors that can make ischemic limb more likely are:

  • Smoking.

  • High blood pressure.

  • Diabetes.

  • High cholesterol levels.

  • Abnormal heart rhythms (for example, a common one called "atrial fibrillation")

  • Past operations on the heart and/or blood vessels.

  • Past problems with blood clots.

  • Past injury (such as burns or a broken bone) that damaged blood vessels in the limb.

Other conditions can cause ischemic limb, although these are rare. They include:

  • Buerger's disease, caused by inflamed blood vessels in the hands and feet. This is also called thromboangiitis obliterans.

  • Some forms of arthritis.

  • Rare birth defects affecting the arteries of the legs.

SYMPTOMS

The major signs and symptoms of ischemic limb are:

  • Pain in the leg while resting (also called "rest pain"). This is sometimes described as a burning pain in the foot that gets worse when lying down.

  • The leg or arm is cool to the touch.

  • The leg or arm lacks color.

  • The leg or arm will not move.

  • There is numbness, a tingling or a prickling sensation in the limb.

  • Blood flow or pulse cannot be found by your caregiver in the arm or leg.

DIAGNOSIS

In diagnosing ischemic limb a caregiver considers:

  • The person's description of how the leg or arm has been feeling.

  • The results of the caregiver's own examination.

  • Blood tests.

PROGNOSIS

With timely emergency treatment, there is a greater than 50-50 chance that a caregiver can fix or remove the block in the artery that is causing the ischemic limb. This could require medication and, possibly, an operation.

If medical care is not gotten quickly enough, the limb might need to be surgically removed (amputated).

TREATMENT

Possible treatments for ischemic limb include:

  • Medications to break down blood clots and let blood flow more easily. These medicines must be given directly into a blood vessel and requires staying the hospital.

  • Revascularization, which is surgery to improve blood flow by putting in new blood vessels.

  • Angioplasty, which is surgery that places a small balloon in an artery to open blood flow.

  • Surgery to place a stent (a flexible metal tube) in an artery to keep it open.

  • Amputation, which is surgical removal of some or all of the affected limb.

RELATED COMPLICATIONS

People who are treated for acute ischemic limb are more likely to:

  • Have more-than-normal bleeding caused by blood-thinning medications.

  • Have ongoing pain.

  • Develop an infection in the arm or leg.

If surgery is needed, possible complications could include:

  • A possible need for blood transfusions.

  • Infection.

  • Swelling inside the limb that squeezes the blood vessels. This is called "Compartment Syndrome", a condition that requires more surgery.

  • A long recovery time.

  • Loss of mobility.

  • A need for amputation.

  • The need for more surgery.