• Acute extremity ischemia occurs due to sudden and complete occlusion of the main arterial supply to an extremity. Etiologies can be divided into embolic and non-embolic events. • It is characterized by the “6 Ps”: pain, paresthesias, pulselessness, pallor, paresis, and poikilothermy. Paralysis is a late finding. Severity of symptoms often correlates with severity of ischemia with only 6–8 h before irreversible ischemic changes if untreated. Rapid diagnosis followed by prompt re-establishment of blood flow will decrease limb loss and overall morbidity and mortality. • Key aspects of management include systemic anticoagulation (heparin drip with bolus), IV hydration while obtaining an H&P, and re-establishing blood flow in a timely fashion. • Surgery of choice: embolectomy for acute embolic events, arteriogram, catheter-directed thrombolysis, mechanical thrombectomy, or endovascular stenting for non-embolic events.