Rapidly Progressive Acute Limb Ischemia With Irreversible Gangrene and Major Amputation in a Resource-Limited...

Acute limb ischemia (ALI) is a vascular emergency in which delayed recognition and treatment can result in irreversible tissue necrosis, gangrene, limb loss, and potentially life-threatening systemic complications. We present the case of a 63-year-old woman with atrial fibrillation and heart failure who developed acute lower-limb ischemia with progressive discoloration and tissue necrosis. Lower-extremity arterial Doppler ultrasonography demonstrated extensive arterial occlusive disease with absent flow across multiple major arterial segments, confirming severe limb ischemia. Serial clinical photographs documented progressive cyanotic and violaceous discoloration with later bullous formation and worsening ischemic tissue injury in the setting of established gangrene. Vascular assessment concluded that the affected limb was no longer salvageable by revascularization. Because reperfusion of extensively necrotic tissue was considered to carry substantial risk of local and systemic reperfusion complications, major limb amputation was recommended. The patient subsequently underwent definitive amputation of the nonviable limb. This case illustrates the narrow therapeutic window in ALI and emphasizes the importance of early recognition, prompt vascular assessment, and timely revascularization before irreversible ischemia develops. Once extensive tissue necrosis and established gangrene occur, primary amputation may represent the appropriate definitive management when limb salvage is no longer feasible.