Vascular surgeons are frequently consulted to evaluate hospitalized patients in the intensive care unit (ICU) with finger ischemia. We sought to characterize causes and outcomes of finger ischemia in ICU patients. All ICU patients who underwent evaluation for finger ischemia from 2008 to 2015 were reviewed. All were evaluated with finger plethysmography. Patient demographics, comorbidities, ICU care (ventilator status, arterial lines, use of vasoactive medications), finger amputations, and survival were recorded. We identified 97 patients (54 male, 43 female). Mean age was 57.3 ± 16.8. Of these patients, 42 (43%) were in the surgical ICU and 55 (57%) in the medical ICU, 70 (72%) had abnormal results on finger plethysmographies, 67 (69%) unilateral and 30 (31%) bilateral, 36 (37%) had ischemia associated with an arterial line, 12 (13%) had concomitant toe ischemia, and 76 (78%) were on vasoactive medications at the time of diagnosis, with the most frequent being phenylephrine (55%), norepinephrine (47%), ephedrine (30%), epinephrine (26%), vasopressin (25%), dopamine (7%), dobutamine (6%).Treatment was with therapeutic anticoagulation in 46 (47%), aspirin in 50 (52%), and clopidogrel in 15 (16%). Other frequent associated conditions included mechanical ventilation at the time of diagnosis (37%), diabetes (33%), history of peripheral vascular disease (32%), dialysis dependence (31%), cancer (24%), and sepsis (20%). Only five patients (5%) ultimately required finger amputation. The 30-day, 1-year, and 2-year survival were 85%, 73%, and 65%. By Cox proportional hazards modelling, cancer (hazard ratio, 6.3; P = .012) and dialysis (hazard ratio, 4.9; P = .026) were independent predictors of mortality. Finger ischemia in ICU patients has a variety of causes but is frequently associated with the presence of arterial lines and the use of vasoactive medications, of which phenylephrine and norepinephrine are the most frequent. Either anticoagulation or antiplatelet therapy is appropriate treatment. While progression to amputation is rare, patients with finger ischemia in the ICU have a high rate of mortality, particularly in the presence of cancer or dialysis.