CIRSE Standards of Practice for the Endovascular Management of Acute Lower Limb Ischaemia

Abstract Background Acute lower limb ischaemia is a medical emergency that requires immediate diagnosis and management to avoid catastrophic consequences. As an alternative to open surgical procedures, endovascular intervention is a minimally invasive approach that can be effective in appropriately selected patients, with outcomes comparable to open surgery in contemporary series. The ongoing improvement and expansion of techniques and tools continue to refine clinical outcomes. Purpose CIRSE Standards of Practice documents recommend a reasonable approach to, and best practices for, performing procedures, in this case, endovascular procedures to restore flow in acute lower limb ischaemia. Methods The writing group, established by the CIRSE Standards of Practice Committee on the recommendation of the Endovascular Subcommittee of CIRSE, consisted of five clinicians with internationally recognised expertise in acute lower limb ischaemia and one research assistant. The writing group reviewed the existing literature and conducted a pragmatic evidence search utilising PubMed to identify publications in English pertaining to human subjects from 2013 to 2025. The final recommendations were developed through consensus, incorporating relevant and valid older primary sources, including the 2011 CIRSE Standards of Practice document. Results Endovascular techniques are established in the treatment of acute lower limb ischaemia and are associated with high technical success rates, which correlate with improved clinical outcomes. Regular follow-up surveillance is recommended to achieve good long-term results.