Endovascular and Thrombolytic Therapy for Upper and Lower Extremity Acute Limb Ischemia

  • Sarah S. Elsayed
  • Leonardo C. Clavijo


This chapter focuses on the endovascular treatment options for acute limb ischemia (ALI) of the upper and lower extremities, namely, endovascular and thrombolytic therapies. ALI is associated with a high risk of loss of limb and life and thus requires prompt diagnosis. ALI is defined as a vascular emergency characterized by an abrupt loss of limb perfusion that threatens tissue viability presenting within 14 days of symptom onset. More than 200,000 patients suffered from lower extremity ALI in the USA in 2000. Estimated hospital mortality was 10 % and >1 in eight underwent in-hospital amputation. There are four clinical categories of ALI, which include limbs that are viable, marginally threatened, immediately threatened, and irreversibly damaged. Rutherford proposed an algorithm for ALI; after history and physical, Doppler examination confirmation of the diagnosis of ALI, heparin should be initiated. ALI Rutherford category I (if early intervention is appropriate) and IIA patients should proceed to angiography. These patients may undergo catheter-directed thrombolysis (CDT) with or without mechanical thrombectomy or surgical thrombo-embolectomy. For Rutherford category IIB patients, one must consider emergent surgery and late category III, delayed amputation.


Endovascular Thrombolytic Treatment Acute Limb Ischemia 

Supplementary material

Video 38.1

Axillary bifemoral bypass graft angiogram before intervention shows complete occlusion of the graft at the origin (MP4 2743 kb)

Video 38.2

Axillary bifemoral bypass graft angiogram after intervention shows complete resolution of thrombus and open bypass graft from the origin to the femoral artery and with flow in the superficial femoral artery (MP4 7407 kb)


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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Sarah S. Elsayed
    • 1
  • Leonardo C. Clavijo
    • 1
  1. 1.Interventional Cardiology, Division of Cardiovascular MedicineUniversity of Southern CaliforniaLos AngelesUSA

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