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Background <p>With a&#xa0;1-year mortality rate of approximately 50%, acute limb ischemia (ALI) is one of the most critical vascular emergencies. Given this high mortality, selecting a&#xa0;patient-specific optimal treatment regimen is essential for clinical success.</p> Objective <p>In light of the high mortality rates, this article addresses how a&#xa0;combination of classical surgery and modern endovascular procedures can achieve optimal, individualized treatment for acute limb ischemia.</p> Material and method <p>Current treatment strategies for acute arterial limb occlusion are presented based on a&#xa0;literature review and clinical experience.</p> Results <p>The PROMOTE-ALI study provides landmark evidence that Rutherford&#xa0;III ischemia no longer necessitates primary amputation. Substantial technical advances in revascularization have enabled high limb salvage rates even in advanced stages. Despite the endovascular evolution, open surgery remains the indispensable standard in over 50% of cases, utilizing procedures such as Fogarty thrombectomy, patch angioplasty or bypass grafting. Complementarily, mechanical thrombectomy and atherectomy procedures enable faster recanalization with minimized foreign body implantation. Hybrid strategies offer optimal solutions, particularly for complex multilevel diseases. Special requirements arise in traumatic vascular injuries with concomitant soft tissue damage and iatrogenic pediatric vascular trauma, the latter of which can often be successfully managed conservatively.</p> Conclusion <p>Despite the vast array of endovascular options, open surgical revascularization remains an indispensable standard in emergency care. Future decisions regarding primary amputation should not rely solely on clinical findings but should be objectified through the development of specific biomarkers.</p>

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Der akute arterielle Extremitätenverschluss – Aktuelle Behandlungsstrategien

  • 期刊论文

  • 发表日期：

    2026年4月17日

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  • Susanne Regus

摘要

Background

With a 1-year mortality rate of approximately 50%, acute limb ischemia (ALI) is one of the most critical vascular emergencies. Given this high mortality, selecting a patient-specific optimal treatment regimen is essential for clinical success.

Objective

In light of the high mortality rates, this article addresses how a combination of classical surgery and modern endovascular procedures can achieve optimal, individualized treatment for acute limb ischemia.

Material and method

Current treatment strategies for acute arterial limb occlusion are presented based on a literature review and clinical experience.

Results

The PROMOTE-ALI study provides landmark evidence that Rutherford III ischemia no longer necessitates primary amputation. Substantial technical advances in revascularization have enabled high limb salvage rates even in advanced stages. Despite the endovascular evolution, open surgery remains the indispensable standard in over 50% of cases, utilizing procedures such as Fogarty thrombectomy, patch angioplasty or bypass grafting. Complementarily, mechanical thrombectomy and atherectomy procedures enable faster recanalization with minimized foreign body implantation. Hybrid strategies offer optimal solutions, particularly for complex multilevel diseases. Special requirements arise in traumatic vascular injuries with concomitant soft tissue damage and iatrogenic pediatric vascular trauma, the latter of which can often be successfully managed conservatively.

Conclusion

Despite the vast array of endovascular options, open surgical revascularization remains an indispensable standard in emergency care. Future decisions regarding primary amputation should not rely solely on clinical findings but should be objectified through the development of specific biomarkers.