Management of Acute Limb Ischaemia in a Nigerian Tertiary Hospital: A Professional Practice Review

Acute limb ischaemia is a vascular emergency requiring timely diagnosis and revascularization to prevent limb loss and death. In Nigerian tertiary hospitals, delays in diagnosis and limited vascular surgical capacity create significant challenges in management. This professional practice review examines the management of acute limb ischaemia at a tertiary hospital in Katsina State, North West Nigeria, from 2020 to 2023. Fifty-two cases were retrospectively reviewed, documenting aetiology, clinical classification using the Rutherford-Becker criteria, interventions performed, time to revascularization, amputation rates, and in-hospital mortality. Embolism was the leading cause in 58% of cases, predominantly from atrial fibrillation. Revascularization was achieved via thromboembolectomy in 61% of patients, while 27% underwent primary amputation due to advanced ischaemia. The mean time from symptom onset to surgical intervention was 28 hours, exceeding the critical 6-hour window. Amputation rate was 35%, and mortality was 13%. Absence of vascular surgeons on call and diagnostic imaging delays were identified as the primary system failures. The study recommends the appointment of dedicated vascular surgeons, 24-hour duplex ultrasound availability, and anticoagulation initiation protocols for emergency physicians managing suspected acute limb ischaemia in North West Nigeria. Keywords: acute limb ischaemia, thromboembolectomy, vascular surgery, Katsina, amputation