Acute limb ischemia (ALI) is a life-threatening condition that requires immediate intervention to prevent severe complications, including limb loss and death. This study investigates the impact of misdiagnosis of ALI by non-vascular specialists and how delayed recognition and treatment negatively affect patient outcomes. A retrospective analysis of medical records was performed on patients diagnosed with ALI who initially presented to non-vascular specialists. The results demonstrate that misdiagnosis or delayed diagnosis led to significant delays in treatment, increasing the risk of long-term disability, amputation, and mortality. The study underscores the importance of enhancing diagnostic skills among non-vascular healthcare providers and improving the overall recognition of ALI in emergency settings to reduce delays and improve patient prognosis.

Acute limb ischemia, misdiagnosis, non-vascular specialists

Acar, R.D.; Sahin, M.; Kirma, C. One of the most urgent vascular circumstances: Acute limb ischemia. SAGE Open Med. 2013, 1, 2050312113516110. [Google Scholar] [CrossRef] [PubMed]

Chioncel, V.; Brezeanu, R.; Sinescu, C. New Directions in the Management of Peripheral Artery Disease. Am. J. Ther. 2019, 26, e284–e293. [Google Scholar] [CrossRef] [PubMed]

Galyfos, G.; Chamzin, A.; Intzes, N.; Matthaiou, G.; Spiliotopoulos, S.; Sotirakis, D.; Sigala, F.; Filis, K. Acute limb ischemia. J. Cardiovasc. Surg. 2023, 64, 396–405. [Google Scholar] [CrossRef] [PubMed]

Rosenberg, H.; Rosenberg, E.; Kubelik, D. Acute limb ischemia. Can. Med. Assoc. J. 2023, 195, E1383. [Google Scholar] [CrossRef]

Gornik, H.L.; Aronow, H.D.; Goodney, P.P.; Arya, S.; Brewster, L.P.; Byrd, L.; Chandra, V.; Drachman, D.E.; Eaves, J.M.; Ehrman, J.K.; et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024, 149, e1313–e1410. [Google Scholar] [CrossRef]

Juneja, A.; Garuthara, M.; Talathi, S.; Rao, A.; Landis, G.; Etkin, Y. Predictors of poor outcomes after lower extremity revascularization for acute limb ischemia. Vascular 2024, 32, 632–639. [Google Scholar] [CrossRef]

Björck, M.; Earnshaw, J.J.; Acosta, S.; Gonçalves, F.B.; Cochennec, F.; Debus, E.; Hinchliffe, R.; Jongkind, V.; Koelemay, M.J.; Menyhei, G.; et al. Editor’s Choice: European Society for Vascular Surgery (ESVS) 2020 clinical practice guidelines on the management of acute limb ischaemia. Eur. J. Vasc. Endovasc. Surg. 2020, 59, 173–218. [Google Scholar] [CrossRef]

Korabathina, R.; Weintraub, A.R.; Price, L.L.; Kapur, N.K.; Kimmelstiel, C.D.; Iafrati, M.D.; Ali Tahir, S.M. Twenty-year analysis of trends in the incidence and in-hospital mortality for lower-extremity arterial thromboembolism. Circulation 2013, 128, 115e21. [Google Scholar] [CrossRef]

Rutherford, R.B.; Baker, J.; Ernst, C.; Johnston, K.; Porter, J.M.; Ahn, S.; Jones, D.N. Recommended standards for reports dealing with lower extremity ischemia: Revised version. J. Vasc. Surg. 1997, 26, 517e38. [Google Scholar] [CrossRef]

Gratl, A.; Busch, A.; Caradu, C.; Doukas, P.; Noronen, K.; Predenciuc, A.; Tran, L.; Zielasek, C.; Zlatanovic, P.; Enzmann, F.K.; et al. Prospective multicentre observational study evaluating acute lower limb ischaemia (PROMOTE-ALI). Br. J. Surg. 2024, 11, znae230. [Google Scholar] [CrossRef]

Baril, D.T.; Ghosh, K.; Rosen, A.B. Trends in the incidence, treatment, and outcomes of acute lower extremity ischemia in the United States Medicare population. J. Vasc. Surg. 2014, 60, 669–677.e2. [Google Scholar] [CrossRef] [PubMed]

Davis, F.M.; Albright, J.; Gallagher, K.A.; Gurm, H.S.; Koenig, G.C.; Schreiber, T.; Grossman, P.M.; Henke, P.K. Early Outcomes following Endovascular, Open Surgical, and Hybrid Revascularization for Lower Extremity Acute Limb Ischemia. Ann. Vasc. Surg. 2018, 51, 106–112. [Google Scholar] [CrossRef] [PubMed]

Herzig, M.S.; Kennedy, K.F.; Hawkins, B.M.; Secemsky, E.A. Contemporary Practice Patterns and Outcomes of Endovascular Revascularization of Acute Limb Ischemia. JACC Cardiovasc. Interv. 2024, 17, 2379–2390. [Google Scholar] [CrossRef] [PubMed]

Ferrer, C.; Cannizzaro, G.A.; Borlizzi, A.; Caruso, C.; Giudice, R. Acute ischemia of the upper and lower limbs: Tailoring the treatment to the underlying etiology. Semin. Vasc. Surg. 2023, 36, 211–223. [Google Scholar] [CrossRef] [PubMed]

Nordanstig, J.; Behrendt, C.A.; Baumgartner, I.; Belch, J.; Bäck, M.; Fitridge, R.; Hinchliffe, R.; Lejay, A.; Mills, J.L.; Rother, U.; et al. Editor’s Choice—European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication. Eur. J. Vasc. Endovasc. Surg. 2024, 67, 9–96. [Google Scholar]

Arnold, J.; Koyfman, A.; Long, B. High risk and low prevalence diseases: Acute limb ischemia. Am. J. Emerg. Med. 2023, 74, 152–158. [Google Scholar] [CrossRef]

Londero, L.S.; Nørgaard, B.; Houlind, K. Patient delay is the main cause of treatment delay in acute limb ischemia: An investigation of pre- and in-hospital time delay. World J. Emerg. Surg. 2014, 9, 56. [Google Scholar] [CrossRef]

Lyden, S.P.; Shortell, C.K.; Illig, K.A. Reperfusion and compartment syndromes: Strategies for prevention and treatment. Semin. Vasc. Surg. 2001, 14, 107–113. [Google Scholar] [CrossRef]