Contributor: Peter Bakes, MD Educational Pearls: Classically presents with the 6Ps: Pain, pallor, paresthesia, pulseless, poikilothermia (cold), and paralysis Acute limb ischemia occurs by embolic or thrombotic causes Thrombotic causes are now more common due to aging populations and advancements in vascular surgery like stents which can be a nidus for thrombosis. Sudden onset of pain without prior symptoms is more typical of embolic causes Preceding symptoms leading to acute ischemia are more often from thrombosis Diagnosis can be clinical based on absent pulses, ultrasound or CT angiogram Definitive treatment includes thrombectomy, stenting, or bypass surgery to restore the blood flow to the distal limb References McNally MM, Univers J. Acute Limb Ischemia. Surg Clin North Am. 2018 Oct;98(5):1081-1096. doi: 10.1016/j.suc.2018.05.002. PMID: 30243449. Summarized by Jackson Roos, MS4 | Edited by Erik Verzemnieks, MD