Acute limb ischaemia is defined as any sudden or rapidly developing decrease in arterial limb perfusion due to embolic occlusion or arterial thrombosis. Due to demographic trends, the incidence of acute limb ischaemia is expected to increase. Timely recognition and treatment of acute limb ischaemia as a medical emergency are critical to shorten the duration of ischaemia as much as possible. Despite major advances in the modern treatment of peripheral arterial disease, particularly the development of various endovascular mechanical thrombectomy systems, acute lower limb ischaemia is still associated with a substantial risk of limb loss and mortality. Ideally, patients should be treated by a vascular team consisting of endovascular specialists and vascular surgeons that can provide quick access to both endovascular and surgical revascularization techniques. This section highlights the clinical presentation, diagnostic steps and therapeutic management options of acute limb ischaemia.