Recommendations for Diagnostic Evaluation of the Cause of ALI
COR	LOE	Recommendations
I	C-EO	In the patient with ALI, a comprehensive history should be obtained to determine the cause of thrombosis and/or embolization.
N/A		In addition to identifying a known history of PAD, the history should focus on uncovering clinical evidence of other conditions that can result in ALI through either embolic or thrombotic mechanisms. These conditions include atrial fibrillation, left ventricular thrombus, aortic dissection, trauma, hypercoagulable state, and presence of a limb artery bypass graft. The clinical history should identify the presence or absence of a history of MI, symptoms and signs of left ventricular dysfunction resulting in congestive heart failure, or possible endocarditis. The history should evaluate for possibility of deep vein thrombosis with intracardiac shunt (eg, patent foramen ovale or other that may result in paradoxical arterial embolism), hypercoagulable state, and family history of thrombosis.
IIa	C-EO	In the patient with a history of ALI, testing for a cardiovascular cause of thromboembolism can be useful.
N/A		Treatment of ALI should not be delayed for testing for the underlying cause of the limb ischemia. Delay from symptom onset to revascularization is a major determinant of outcome.360,361 The evaluation of a cardiovascular cause of ALI is most useful in the patient without underlying PAD. Evaluation for cardiovascular cause includes electrocardiogram or additional heart rhythm monitoring to detect atrial fibrillation, electrocardiogram to detect evidence of MI, and echocardiography to further determine whether there is a cardiac etiology for thromboembolism, such as valvular vegetation, left atrial or left ventricular thrombus, or intracardiac shunt.387