Acute limb ischemia is considered one of the most demanding acute vascular pathologies requiring immediate intervention as it is associated with morbidity and mortality.The Rutherford classification for acute limb ischemia is a helpful management guide, as defined by the Society for Vascular Surgery and the International Society for Cardiovascular Surgery.Recently, the popularity of percutaneous interventions has been reflected in this guideline-classification and has been an important step in the treatment of acute limb ischemia.However, surgical and medical treatment options should not be overlooked.We know that right diagnosis and management in emergency department is vital part of this process.That's why, in this case report, we discussed what should do and what should not do in a patient with acute lower extremity ischemia in the light of this guideline-classification.