50
Treatment
11.2.1. Revascularization for ALI
COR LOE
Recommendations
1 A
1. In patients with ALI and a salvageable limb, revascularization
(endovascular or surgical, including catheter-directed
thrombolysis) is indicated to prevent amputation.
2a C-EO
2. In patients with ALI and a salvageable limb who are
treated with catheter-directed thrombolysis, adjunctive
revascularization (ie, endovascular, or surgical) procedures
can be useful.
2b C-LD
3. In patients presenting with ALI from chemotherapeutic
or prothrombotic viral states, it may be reasonable to take
a more deliberate planning strateg y before engaging in a
definitive revascularization or medical treatment plan.
3: Harm C-EO
4. In patients with ALI with a nonsalvageable limb,
revascularization of nonviable tissue should not be
performed.
11.2. Management of ALI
11.1. Initial Clinical Evaluation and Diagnostic Approach
to ALI
COR LOE
Recommendations
1 C-EO
1. Patients with ALI should be evaluated on an emergency basis
by a clinical with sufficient experience to assess limb viability
and implement appropriate therapy.
1 C-LD
2. In patients with suspected ALI, the initial clinical evaluation
should rapidly assess limb viability and potential for salvage
and can be achieved without noninvasive imaging (ie, duplex
ultrasound, CTA, or MRA).
2b C-EO
3. In patients with ALI who have a complicated history of
revascularization procedures, it may be reasonable to obtain
noninvasive imaging (ie, duplex ultrasound, CTA, or MRA)
before deciding to proceed with revascularization.
11. Acute Limb Ischemia
