Part II: Acute Lower Limb Ischemia-Reperfusion Injury: Contemporary Clinical Management and Review of Randomized Controlled Trials

Abstract

Acute limb ischemia (ALI) is a medical emergency that can be due to prolonged tourniquet application, peripheral arterial disease, arterial embolization, and/or arterial thrombosis. To prevent associated morbidity and mortality, ischemia time should be minimized by urgent or emergent revascularization. However, revascularization can lead to ischemia-reperfusion injury (IRI), a devastating complication that can cause limb loss, multi-organ failure, and/or death. Currently, management of IRI largely relies on preventative measures and supportive care. In Part 2 of this two-part review article, we will briefly review the pathophysiology of IRI discussed in Part 1, and then discuss contemporary interventions to perfuse an acutely ischemic limb, clinical strategies that have been used to reduce and/or prevent IRI, and lastly, randomized controlled trials that have investigated pharmacological interventions to neutralize or mitigate IRI toxicity.