Patterns, Clinical Management, and Outcomes of Acute Limb Ischemia: An Observational Study in Emergency Departments of Government Hospitals in Northern Border, Saudi Arabia

Objectives: Acute limb ischemia (ALI) is a vascular emergency characterized by a sudden reduction in limb perfusion, threatening limb viability. It affects 10-12 individuals per 100,000 annually in Europe, with common causes including arterial thrombosis, embolism due to cardiac disease, and trauma. Timely intervention typically within 6 to 12 hours is critical to avoid irreversible damage, amputation, or death. The Rutherford Classification system provides a standardized framework to stratify the severity of ALI and guide management. Objective: To evaluate the clinical patterns, management strategies, and outcomes of adult patients presenting with acute limb ischemia in government emergency departments in Northern Saudi Arabia from October, 2021 to December, 2024. Methods: This observational analytic study was conducted at two tertiary care hospitals North Medical Tower Hospital and Prince Abdulaziz Bin Musaad Hospital. Data were retrospectively collected from medical records of adult patients presenting with post-traumatic or thromboembolic ALI. Variables included demographic details, comorbidities, Injury Severity Score (ISS), transfer timing, Rutherford classification, imaging and intervention details, and clinical outcomes. Results: A total of 27 patients with ALI were identified. The majority were males (81.4%), aged 40-60 years (55.5%). Common comorbidities included hypertension (33.3%), smoking (37%), and diabetes (14.8%). Most cases involved the lower limb (85.1%), with trauma and arterial thrombosis being the predominant etiologies. Preoperative CT angiography was performed in 55.5% of cases, particularly in Rutherford Class IIa and IIb patients. Class I (viable) was the most frequent presentation (85.1%), followed by Class IIa (7.4%), IIb (3.7%), and Class III (3.7%). Catheter-directed thrombolysis (48.1%) and surgical embolectomy (40.7%) were the most common interventions. Limb salvage was achieved in 92.5% of patients. Amputation was required in one Class III case, and one mortality occurred in a Class IIb case presenting with atrial fibrillation. Conclusion: The Rutherford Classification is a valuable tool for prognostication and decision-making in ALI. Lower limb involvement is more prevalent and associated with poorer outcomes, particularly when referral and intervention are delayed. Early recognition, timely referral to vascular surgery, and appropriate use of thrombolysis or embolectomy are crucial for optimizing limb salvage in resource-limited settings.