Objectives: This study aimed to determine whether red cell distribution width (RDW) is an independent predictor of adverse outcomes in patients who underwent surgical embolectomy for acute lower limb ischemia. Patients and methods: This retrospective study included 245 patients who underwent surgical embolectomy for acute lower limb ischemia between January 2008 and June 2012. Patients who had thrombosis of the atherosclerotic lesion and iliac or femoral stent thrombosis were excluded. The patients were divided into two groups according to the need for limb amputation after the initial embolectomy: 42 were in the limb amputation group (33 males, 9 females; mean age: 67.2±9.1 years; range, 52 to 85 years), and 203 were in the limb salvage group (132 males, 71 females; mean age: 58.4±9.3 years; range, 44 to 71 years). A multinomial logistic regression analysis was applied to determine the independent predictive effect of RDW and other parameters on major/minor amputation. The analysis was multivariately adjusted for age and sex to eliminate the confounding effect of other variables. Results: Age (odds ratio [OR]=1.131, 95% confidence interval [CI]: 1.074-1.191, p<0.001), recurrent embolism in the same limb (OR=2.898, 95% CI: 1.238-6.780, p=0.01), urea level (OR=1.037, 95% CI: 1.013-1.062, p=0.003), and RDW (OR=1.324, 95% CI: 1.006-1.741, p=0.04) were significantly associated with the risk of major amputation in unadjusted multinominal logistic regression analysis, whereas the association of RDW with the risk of major amputation did not remain when adjusted for age and sex (OR=1.191, 95% CI: 0.963-1.474, p=0.10). Conclusion: In conclusion, RDW may have a role in predicting adverse outcomes in patients treated for acute lower limb ischemia. However, it cannot be used as a stand-alone predictive marker.