Patients with acute arterial limb ischemia typically present with one of the “six Ps”: pain, pallor, poikilothermia (coldness), pulselessness, paresthesias, and paralysis. Pain is the earliest symptom and may increase with elevation of the limb. Changes in skin color with mottling, splotchiness, and cool temperature are common. One of the early signs of ischemic limb pain may present as muscle weakness. Limb viability may be in question when there is acute anesthesia progressing to paralysis. A decreased pulse distal to the obstruction is an unreliable finding for early ischemia, especially in patients with peripheral vascular disease and well-developed collateral circulation. Claudication refers to a cramplike pain, ache, or tiredness that is brought on by exercise and relieved by rest. It is reproducible, resolves within 2 to 5 min of rest, and reoccurs at consistent walking distances. The pain of acute limb ischemia is not well localized, is not relieved by rest or gravity, and can be a worsening of chronic pain (if it is caused by a thrombotic event).