A patient presents with acute limb ischemia (6 hours duration) of the left leg — cold, pale, pulseless, with paresthesia but no motor loss. This corresponds to which Rutherford category?

• A Category I — viable limb, no immediate threat
• B Category IIb — immediately threatened, sensory and motor intact but neurological deficit present ✓
• C Category IIa — marginally threatened, no sensory loss
• D Category III — irreversible ischemia, major tissue loss inevitable

Explanation

Rutherford classification for acute limb ischemia: Category I — viable (no sensory/motor deficit, audible venous/arterial Doppler). Category IIa — marginally threatened (minimal sensory deficit only, Doppler signals present). Category IIb — immediately threatened (sensory deficit in the ischemic area plus motor deficit or rest pain, absent Doppler). Category III — irreversible (profound motor paralysis, skin mottling/marbling, absent Doppler). This patient with paresthesia (sensory deficit) but no motor loss may represent IIa, but paresthesia with pulselessness and the acute presentation of 6 hours typically represents IIb requiring emergent revascularization. Category IIb requires immediate surgical or endovascular intervention to avoid limb loss.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.