A 55-year-old woman presents with severe left leg pain at rest, pallor, paraesthesia, pulselessness, and coolness below the knee for 3 hours. She is in atrial fibrillation. The Rutherford classification and appropriate treatment are:

• A Rutherford IIa; urgent catheter-directed thrombolysis
• B Rutherford III; primary amputation
• C Rutherford IIb; emergency revascularisation (surgical embolectomy or hybrid procedure) ✓
• D Rutherford I; anticoagulation and observation

Explanation

This patient has acute limb ischaemia with sensory loss and motor weakness (pain, pallor, paraesthesia, pulselessness — 6 Ps minus polar), classifying as Rutherford Class IIb (immediately threatened limb — incomplete sensory/motor loss). Emergency surgical embolectomy (Fogarty catheter) or hybrid revascularisation is mandated; thrombolysis is too slow for IIb. Class III (irreversible ischaemia with rigor) requires amputation.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.