© 2015 Elsevier Inc. Background: Acute limb ischemia (ALI), although uncommon, can present with profound symptoms, including disabling pain in the setting of acute vascular and neurologic deficits. The most appropriate diagnostic and therapeutic strategy has evolved with emerging technologies inclusive of less-invasive endovascular diagnostic and therapeutic options. Objective: We present a case of ALI to illustrate the diagnostic and therapeutic approaches with a summary of the most common literature. Discussion: Utilizing the clinical findings applied to the Rutherford classification, the emergency physician, in consultation with a vascular surgeon and interventional radiologist, can strategize a methodical approach for better clinical outcomes, often with less-invasive endovascular interventions, ideally within 6 h of symptom onset. Conclusions: We present a case of ALI to illustrate the diagnostic and therapeutic approach with a summary of the most current literature. Emergency physicians should be aware of optimized clinical outcomes with the use of time-sensitive enhanced endovascular therapies as a recommended option for the best outcomes for the treatment of ALI.