Management of acute limb ischemia in lower extremity peripheral arterial disease

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AHA/ACC Guidelines on Management of Lower Extremity PAD
Guidelines for Clinical Assessment of Lower Extremity PAD
Guidelines for Diagnostic Testing for suspected PAD
Guidelines for Screening for Atherosclerotic Disease in Other Vascular Beds in patients with Lower Extremity PAD
Guidelines for Medical Therapy for Lower Extremity PAD
Guidelines for Structured Exercise Therapy for Lower Extremity PAD
Guidelines for Minimizing Tissue Loss in Lower Extremity PAD
Guidelines for Revascularization of Claudication in Lower Extremity PAD
Guidelines for Management of CLI in Lower Extremity PAD
Guidelines for Management of Acute Limb Ischemial in Lower Extremity PAD
Guidelines for Longitudinal Follow-up for Lower Extremity PAD
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease

Recommendations for Management of Acute Limb Ischemia (ALI)

Recommendations for Clinical Presentation of ALI:

Class I

"1. Patients with ALI should be emergently evaluated by a clinician with sufficient experience to assess limb viability and implement appropriate therapy. (Level of Evidence: C-EO)"

"2. In patients with suspected ALI, initial clinical evaluation should rapidly assess limb viability and potential for salvage and does not require imaging. (Level of Evidence: C-LD)"

Recommendation for Medical Therapy of ALI:

Class I

"1. In patients with ALI, systemic anticoagulation with heparin should be administered unless contraindicated. (Level of Evidence: C-EO)"

Recommendations for Revascularization for ALI:

Class I

"1. In patients with ALI, the revascularization strategy should be determined by local resources and patient factors (e.g., etiology and degree of ischemia).(Level of Evidence: C-LD)"

"2.Catheter-based thrombolysis is effective for patients with ALI and a salvageable limb. (Level of Evidence: A)"

"3.Amputation should be performed as the first procedure in patients with a non salvageable limb. (Level of Evidence: C-LD)"

"4.Patients with ALI should be monitored and treated (e.g., fasciotomy) for compartment syndrome after revascularization. (Level of Evidence: C-LD)"

Class IIa

"1. In patients with ALI with a salvageable limb, percutaneous mechanical thrombectomy can be useful as adjunctive therapy to thrombolysis. (Level of Evidence: B-NR)"

"2.In patients with ALI due to embolism and with a salvageable limb, surgical thromboembolectomy can be effective.(Level of Evidence: C-LD)"

Class IIb

"1. The usefulness of ultrasound-accelerated catheter-based thrombolysis for patients with ALI with a salvageable limb is unknown. (Level of Evidence: C-LD)"

Recommendations for Diagnostic Evaluation of the Cause of ALI:

Class I

"1. In the patient with ALI, a comprehensive history should be obtained to determine the cause of thrombosis and/or embolization.(Level of Evidence: C-EO)"

Class IIa

"1. In the patient with a history of ALI, testing for a cardiovascular cause of thromboembolism can be useful. (Level of Evidence: C-EO)"