Classifications

Classes based on threat to limb

Class	Threat to limb	Key Sign
I	N/A	No neurological S/S
II.a	Marginal	No neurological S/S (except toe parasthesia)
II.b	Immediate	Pain at rest, moderate parasthesia paralysis
III	Non-salvagable	Profound paralysis and parasthesia

Etiologies

“Acute CLI” → from nothing to CLI
- Arterial Embolism ALIs (4)
- Thrombosis ALI (4)
“Acute on Chronic / progressive chronic disease
- PAD - Peripheral Arterial Disease

	Arterial Embolism ALIs (4)	Thrombosis ALI (4)	PAD - Peripheral Arterial Disease
Etiology (Ask in Hx)	1. Cardiac Embolism (AFib, IE, Mechanical valve)

‣ - Atheroembolism
Aortic Mural Thrombi (+/- AAA)
Paradoxical Emboli (DVT + PFO) | 1. ‣
Hypercoagulative state (DVT, HIIT)
AD
CABG Occlusion | 1. ‣ | | Pathogenesis | thrombus dislodged and occlude vessels else where (arterial bifurcation) | Ccclusion at the site of thrombus formation | starting with stable blockage, without life style modification, developing into CLI as the collateral dies off | | Risk of CLI | +++ | ++ | + |

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Relevant Physiology

Prognosis/Disease Course

Irreversible necrosis after 6h if untreated
Paresthesia + Paralsis = limb threatening
- Amputation rate 13%
- Mortality 10%
- Secondary embolic event (e.g. stroke): 10%
If untreated, die within 24-48 h → !Rhabdomyolysis → !AKI - Acute Kidney Injury
toxin build up in ischemic limb → Inappropriate re-vascularization could lead to worsening outcome (Re-perfusion syndrome )

Presentation

Signs and Symptoms

6P for Ischemia
- Pain → SEVERE!
- Pallor leg (purple, mottled appearance)
- Polar (cold)
- Pusleless
- Paresthesia - sign of threat to limb
- Paralysis - sign of threat to limb