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Early detection and treatment of acute limb ischaemia | Signal

Issue date25 March 2011
This Signal relates to the risks from delayed detection and treatment of acute limb ischaemia.

A sample incident reads:

“Patient attended the emergency department with ischaemic leg. Misdiagnosed as disc problem. ED doctor and Neurosurgery Registrar did not examine for pulses, delay of 27 hours before revascularising leg … led to amputation subsequently.”

Acute limb ischaemia is an emergency and can lead to loss of life or limb if not treated swiftly. If suspected the patient must be referred to a vascular surgeon immediately. The most severely ischaemic limbs require treatment within six hours of onset if permanent damage or amputation is to be avoided.

Acute limb ischaemia should be suspected in any patient with a sudden onset or deterioration of pain in the leg, particularly in those with cardiovascular problems and recent lower limb surgery.
Symptoms of acute limb ischaemia (the six ’P’s) include:
  • Paraesthesia (altered sensation)
  • Pain
  • Pallor (mottled colouration)
  • Pulselessness
  • Paralysis
  • Poikilothermia (coolness)

Serious incidents reported to the National Reporting and Learning System (NRLS) up to April 2010 were searched, and 51 reports of delays in detecting and treating acute limb ischaemia were found. Seven incidents were reported as resulting in death and 44 as severe harm. Underlying causes for these incidents included:
  • diagnostic errors (for example misdiagnosed as a Baker’s cyst or disc problem)
  • acutely ischaemic limbs not recognised as a surgical emergency (monitoring limbs for further deterioration instead of prompt intervention)
  • delays in referrals to vascular surgeons
  • clinical assessment and diagnosis appears inconsistent

The Provision of Emergency Vascular Services (2009) provides healthcare organisations with guidance on how to establish effective care pathways for emergency vascular patients, including those presenting with acute limb ischaemia.

The Clinical Board for Surgical Safety will share these findings with vascular colleagues.  Healthcare organisations should review their local care pathways.

We would like to hear from you – please contact us with your initiatives to reduce risks in this area.  

Signals are notifications of key risks emerging from review of serious incidents reported to the NRLS and shared by the NPSA.