Table 3.19-4. Clinical classification and treatment of acute limb ischemia (based on the Rutherford classification)



Clinical features


Sensory loss

Motor deficit

I. Viable

Not immediately threatened



Thrombolysis or surgery

II. Threatened

– IIa. Marginally

Salvageable if promptly treated

None or minimal (toes)


Thrombolysis or surgery

– IIb. Immediately

Salvageable if promptly revascularized

More than toes

Mild or moderate

Surgery, may be combined with thrombolysis

III. Irreversible

Inevitable high-level amputation or permanent nerve damage

Profound, anesthetic

Profound, paralysis (rigor)

Primary amputation in the case of prolonged ischemic time with low likelihood of improvement and high risk of revascularization; early (6-8 h) embolectomy or thrombectomy may be considered to determine the extent of reversibility or to improve the level of amputation

Adapted from J Vasc Surg. 1997;26(3):517-38 and Eur Heart J. 2011;32(22):2851-906.