A survey of contemporary acute lower limb ischaemia management

Background: Acute limb ischaemia (ALI) is a limb- and life-threatening condition requiring urgent management. Technological advances have led to the implementation of new endovascular devices into practice. This survey aimed to provide a better understanding of the contemporary management of ALI. Methods: An international survey was conducted from December 2022 to February 2023 among clinicians who manage patients with ALI using an online survey tool through mailing lists and social media. Results: 37 responses were received from vascular surgeons and interventional cardiologists from Europe (UK, Italy and Greece), USA and New Zealand. 65% of respondents manage >30 ALI cases annually. Computed tomography (CT) angiography was routinely used for diagnosis and intervention planning. 51% of respondents preferred open surgery for ALI management due to confidence in outcomes and concerns about distal embolisation and bleeding risks associated with endovascular interventions, while 5% preferred endovascular first and 40% used both approaches equally. Approximately 14% of respondents reported lack of endovascular evidence and 5% reported lack of endovascular local expertise. 29% supported the endovascular approach as minimally invasive, while 18% believed it offers faster recovery. 42% reserved the endovascular approach for unfit patients and cases with poor outflow. 10% adopted a selective approach depending on aetiology, clinical severity and predicated endovascular outcome. An interventional radiology room or hybrid availability and leading clinician preference were the key deciding factors for 5% of respondents. Conclusion: The survey results indicate variation in ALI management, steered by clinician expertise but lacking in level 1 evidence. The appetite for further study was high among respondents and could guide optimal ALI management.