Revascularization for Acute Limb Ischemia

Acute limb ischemia (ALI) is a sudden decrease in lower limb arterial perfusion that poses a threat not only to limb viability but alsoto life and requires urgent evaluation and management. The etiology of ALI is broadly divided into embolism and thrombosis, along with various comorbidities. Severity and treatment strategy should be determined based on physical and image findings. Revascularization can be performed surgically (thromboembolectomy or bypass), endovascularly, or through a hybrid procedure. In all cases, it is important to conduct intraoperative angiography and perform the necessary additional procedures. A prompt response to myonephropathic metabolic syndrome or compartment syndrome during or after revascularization is also essential. ALI is a serious condition that requires emergency treatment, and it is important to be familiar with all treatment options, including surgical and endovascular treatments, fasciotomy, and primary limb amputation, and to promptly provide the best available initial treatment at each facility. (This is a translation of Jpn J Vasc Surg 2024; 33: 199-204.).