Critical Limb Ischemia (CLI) Overview

Limb ischemia occurs when the blood flow is limited or blocked, preventing adequate circulation to keep the tissues alive in the extremity. This condition can affect your hands, feet, and legs, and the lack of oxygen and nutrients to the limb tissue causes pain, dysfunction, and ultimately tissue death or gangrene. Critical Limb Ischemia (CLI) is a condition that worsens over time and presents acutely. As the blood vessels narrow, limiting essential blood flow, immediate intervention is often required for limb salvage; otherwise, patients at this stage are at extreme risk for limb amputation.

Critical Limb Ischemia Causes

CLI is the advanced form of peripheral arterial disease (PAD), which is caused by the calcification and hardening of the arteries or atherosclerosis. In the beginning stages of PAD, plaque builds up within the blood vessels and sticks together. This decreases the ability of the blood to flow through the artery properly and limits the oxygen and nutrients needed to keep tissues alive.

Critical Limb Ischemia Risk Factors & Symptoms

Risk Factors

  • Older in age
  • Smoking
  • Diabetes
  • High cholesterol
  • High blood pressure
  • Family history
  • Being overweight
  • Lack of exercise

Symptoms

The easiest way to remember the symptoms of CLI/PAD is the word FLOW. If you are experiencing…
  • Feeling of pain in legs
  • Loss of sensation in the arms and legs
  • Opens sores that won’t heal
  • Weakness with walking
…you have a FLOW problem and are at risk for PAD/CLI.
two risk factors of Critical Limb Ischemia marked on a check list of medical conditions

You Have a Choice When It Comes to Vascular Care.
Get an Appointment at VIC In 1 to 3 days – Without a Referral!

You Have a Choice When It Comes to Vascular Care.
Get an Appointment at VIC In 1 to 3 days – Without a Referral!

Critical Limb Ischemia Diagnosis

An ankle-brachial (ABI)  test will determine how the blood is flowing to your legs. This is a simple non-invasive blood pressure test that will measure the blood pressure in your legs compared to the pressure in your arms.

Critical Limb Ischemia Treatment

Critical Limb Ischemia treatment may include medication management, wound treatment, or vascular surgery. Medications to manage high blood pressure or cholesterol and modifications of lifestyle and eating choices will be the first tier of intervention. Patients with CLI experience issues with chronic wounds or ulcers, requiring wound treatment management. The last option would be for surgical intervention; in most cases, this can be done in an outpatient setting, which would include angioplasty, atherectomy, or stenting, or within the hospital setting, which would include bypass surgery, endarterectomy, or, as a last resort, amputation.

Critical Limb Ischemia Prevention

Critical Limb Ischemia is the natural progression of patients suffering with PAD associated with multiple risk factors. Long-term uncontrolled medical conditions can lead to rapid progression of PAD. So, the best way to prevent progression of the disease is to get control of the risk factors causing the problem, including stopping smoking, controlling hypertension and diabetes, increasing walking activity, and eating a proper diet.

Healthy salad

Critical Limb Ischemia Disease Progression

FAQs

Ulcers in individuals with critical limb ischemia develop because narrowed or blocked arteries restrict proper blood flow to the limbs. This lack of blood flow means tissues don’t receive enough nutrients or oxygen to function and heal effectively, leading to tissue damage and ulcers, which are significant critical limb ischemia symptoms.

With timely and appropriate critical limb ischemia treatment, blood flow to the leg can often be restored. Once circulation is improved, wounds and dying tissue can heal. Surgical procedures, including endovascular options or surgical bypass, are available to help restore blood flow. Differentiating between acute vs critical limb ischemia, where CLI is a more chronic and severe stage, is important for determining the best course of action.

In a critical limb ischemia treatment approach like angioplasty, a balloon-tipped catheter is used to open the blocked artery and improve blood flow. A stent may then be placed inside the vessel to help keep the artery walls open and maintain adequate circulation.

Uncontrolled diabetes significantly increases the risk of vascular disease, including critical limb ischemia, and impairs the body’s ability to heal wounds. Infected wounds pose a serious risk, especially for individuals with diabetes, emphasizing the need for daily foot checks and prompt medical attention for any skin breaks.

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