Acute limb ischemia (ALI) is one of the most common vascular emergencies and characterized by sudden worsening of limb perfusion mainly caused by embolization of thrombotic masses or acute graft occlusion. It is a serious condition with potential thread to limb viability accompanied by significant mortality, morbidity and costs. This article provides an overview of etiology, classification and treatment options of ALI ischemia with special focus on the issue of postreperfusion syndrome. The concept of reperfusion injury following limb ischemia and a system for controlled limb reperfusion to offset postreperfusion synsrome is described in detail.