Acute lower extremity limb ischemia secondary to thromboembolic disease is a common clinical problem with significant associated morbidity and mortality. While embolic sources are primarily cardiogenic in 80–90% of cases, other causes include emboli from proximal atherosclerotic or aneurysmal vessels, paradoxical emboli, and tumors. Additionally, the increase in endovascular techniques has made iatrogenic causes a more commonly appreciated etiology of lower extremity arterial emboli. The majority of embolic material will travel to the lower extremity and lodge near arterial bifurcations, most commonly in the femoral and popliteal arteries.

Patients with thromboembolism of the extremities present with one or more of the six “classic Ps” of limb ischemia: pain, pallor, paresthesia, paralysis, pulselessness, and poikilothermia (cold limb). Since each patient has a critical window before irreversible tissue damage may occur, attempting to determine the duration of symptoms is important. Six hours is commonly considered to be the span before such irreversible damage begins. It cannot be overemphasized that immediate referral to a vascular surgeon is absolutely paramount if a patient presents with acute limb ischemia, as delays in triage or unnecessary imaging can ultimately compromise the potential for limb salvage. Diagnosis can usually be made by history and physical examination, although imaging studies may be necessary to assist with management decisions for some patients.