Microsoft Word - IJHHS IMAM 23rd ASC 2022


  
 

 S23

The Classical 6-P of Acute Limb Ischemia  
  
Adib Zakhi1  
  
Acute limb ischemia (ALI) is a surgical emergency and often threatens limb viability. This is a case of 
a 45-year-old patient who presented with the classical six Ps of ALI.   

A 45-year-old lady with underlying hypertension and heart failure presented with acute right 
leg pain arriving by ambulance at the Emergency Department within 4 hours of the symptom.  The 
patient was clinically obese and seemed very uncomfortable as evidenced by her writhing in pain. She 
was borderline tachycardic and hypertensive. The cardiopulmonary and abdominal examinations were 
unremarkable. On extremity examination, she was unable to move her right leg starting from the knee 
caudally. The leg appeared mottling and cold. On vascular examination, there was no abdominal or 
femoral bruit but there was a diminished pulsation of the right femoral, dorsalis-pedis and posterior-
tibialis arteries as confirmed by Doppler compared to the contralateral side. On the neurological 
examination, the sensation was absent and no pain upon the passive stretch. Ankle-Brachial-Systolic 
Index (ABSI) was 0.7. As evidenced by pain, pallor, pulselessness, poikilothermia, paralysis, and 
paresthesia, clinical diagnosis of acute right leg ischemia was established with most likely vascular 
occlusion proximal to the left femoral artery. The vascular team was urgently referred.  

Electrocardiogram showed sinus tachycardia. Bedside ultrasound revealed normal aortic root 
size and neither aortic dissection nor aneurysm. 2-point compression tests were fully compressible and 
X-ray films showed no fracture. Creatinine Kinase was 65 units/litre whereas other blood parameters 
were unremarkable. She was then classified as Rutherford IIB and underwent a right femoral 
thromboembolectomy.   

The presentation of ALI requires rapid diagnosis and appropriate management as it is time-
sensitive and limb-threatening. Emergency physicians should be aware of advances in endovascular 
therapies as a recommended option for the treatment of ALI.  

  
Keywords: Emergency Department, Vascular, Limb Ischemia   
  

1. Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia    
  
 

 

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Correspondence to:  

Adib Zakhi, Medical Officer, Hospital Canselor Tuanku Muhriz Malaysia, adibzakhi@rocketmail.com 

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DOI: http://dx.doi.org/10.31344/ijhhs.v7i70.525