A 65-year-old man presents with a cold, painful, pulseless right leg 3 hours after onset. Doppler ultrasound at the popliteal level is absent. He has known atrial fibrillation. The ankle-brachial pressure index cannot be obtained. Categorising this as acute limb ischaemia, which Rutherford category describes a viable limb with no motor or sensory loss and audible venous but absent arterial Doppler signals?
- A Category I
- B Category IIb
- C Category IIa ✓
- D Category III
Explanation
The SVS/ISCVS Rutherford classification of acute limb ischaemia: Category I (not immediately threatened) — no sensory or motor loss, audible arterial and venous Doppler. Category IIa (marginally threatened) — minimal or no sensory loss (toes only), no motor deficit, inaudible arterial Doppler but audible venous Doppler. Category IIb (immediately threatened) — sensory loss beyond toes, motor weakness or paralysis, inaudible arterial Doppler. Category III (irreversible) — profound sensory and motor loss, inaudible venous Doppler — non-viable. This patient with absent Doppler but no motor/sensory loss fits Category I; a truly absent arterial Doppler without sensory loss and with audible venous Doppler is Category IIa.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.