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Neurological function

No sensory loss Normal motor function Sensory loss limited to toes No muscle weakness Sensory loss more than toes and rest pain Mild-to-moderate muscle weakness Complete sensory loss and loss of motor function Capillary refill

Intact Slow-intact Slow-absent Absent Arterial Doppler

Audible Inaudible Venous Doppler

Audible

I: Viable IIA: Marginally threatened IIB: Immediately threatened III: Irreversible

Inaudible

Muscle biomarkers

Elevated

Suspected ALI

Acutely cold and painful leg

Pain management

Medical management and follow-up

Imaging (DUS, CTA, DSA, MRA) Imaginga

(DUS, CTA, DSA, MRA)

Urgent revascularization

AND anticoagulation unless contraindicated Emergency revascularization

AND anticoagulation unless contraindicated Primary amputation

or palliative care

Clinical evaluation by experienced clinician

Figure 16 Management of acute limb ischaemia. ALI, acute limb ischaemia; CTA, computed tomography angiography; DSA, digital subtraction angiography; DUS, duplex ultrasound; MRA, magnetic resonance angiography. aShould not delay treatment.

ESC Guidelines                                                                                                                                                                                          3589

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