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Prevention and Management of Urgent/Emergent Limb Ischemia

  • Peripheral Vascular Disease (WS Jones, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Patients who require urgent or emergent peripheral revascularization represent one of the highest risk subgroups of PAD patients. They suffer unacceptably high complication rates including recurrent ALI, vascular amputation, and death. In this article, we examine (1) the burden of cardiovascular complications according to PAD severity, (2) discuss medical optimization to improve vascular outcomes in symptomatic LE-PAD patients, and (3) review the evidence for management of patients following urgent/emergent limb ischemia.

Recent Findings

The VOYAGER trial recently demonstrated that rivaroxaban 2.5 mg BID + ASA daily significantly reduces major adverse cardiac and limb events in patients following lower extremity revascularization. A recent Canadian survey also demonstrated that significant heterogeneity exists in antithrombotic prescribing practices following urgent/emergent revascularization.

Summary

COMPASS and VOYAGER have demonstrated the efficacy of aspirin 81 mg daily and rivaroxaban 2.5 mg twice daily at reducing MACE and MALE events in stable PAD patients and those undergoing elective revascularization. Patients who require urgent or emergent peripheral revascularization remain the highest thrombotic risk subgroup of PAD patients, in whom there is insufficient evidence to guide antithrombotic therapy. Despite clear evidence that multi-modal medical therapy (including statins, antihypertensive agents and smoking cessation) benefits patients with atherosclerosis, their use remains unacceptably low in PAD, and greater efforts are needed to understand and address patient, health provider, and system issues that prevent their optimal implementation in practice.

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Author information

Authors and Affiliations

  1. Division of Vascular Surgery, McMaster University, 237 Barton St East, Hamilton, ON, Canada

    Graham R. McClure

  2. Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St W, Hamilton, ON, Canada

    Graham R. McClure

  3. Population Health Research Institute, 20 Copeland Ave, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada

    Noel Chan, Vinai Bhagirath & Sonia S. Anand

  4. Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, Canada

    Noel Chan, Vinai Bhagirath & Sonia S. Anand

  5. Department of Medicine, University of Toronto, 27 Kings College Cir, Toronto, ON, Canada

    Eric Kaplovitch

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Correspondence to Sonia S. Anand.

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Conflict of Interest

Vinai Bhagirath reports grants from Pfizer, Canada, and personal fees from Bayer. Sonia S. Anand reports consulting fees from Bayer and Janssen. The other authors declare no conflict of interest.

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This article is part of the Topical Collection on Peripheral Vascular Disease

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McClure, G.R., Chan, N., Kaplovitch, E. et al. Prevention and Management of Urgent/Emergent Limb Ischemia. Curr Cardiol Rep 23, 41 (2021). https://doi.org/10.1007/s11886-021-01472-9

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  • DOI: https://doi.org/10.1007/s11886-021-01472-9

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