Key clinical signs and symptoms indicating acute limb ischaemia include the sudden onset of the '6 Ps': pain, pallor, pulselessness, paraesthesia, paralysis, and poikilothermia (coldness) of the affected limb. These features reflect the rapid reduction in arterial blood flow leading to tissue ischaemia and potential limb threat.
Specifically, patients typically present with severe, acute limb pain that is often the first symptom, followed by a pale or mottled appearance of the limb due to lack of perfusion. The affected limb is usually cold to touch (poikilothermia) and pulseless distal to the occlusion site. Sensory changes such as numbness or tingling (paraesthesia) and motor weakness or paralysis may develop as ischaemia progresses, indicating nerve and muscle involvement.
These clinical signs are critical for prompt diagnosis and urgent management to prevent irreversible tissue damage and limb loss NICE CG147 Creager et al. 2012Bagge et al. 2025Ahmed et al. 2025.