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Critical Limb Ischemia (CLI) Overview

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

At VIC, You Don’t Have to Wait 6-8 Weeks to See Us. Our Providers Will See You In 3 to 5 Days – Without a Referral!

At VIC, You Don’t Have to Wait 6-8 Weeks to See Us.
Our Providers Will See You In 3 to 5 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

Patients experiencing the condition of CLI have narrowed or blocked arteries that prevent proper blood flow.  When the blood flow is restricted, the tissues do not get the proper nutrients or oxygen to function, which results in tissues not healing.

With appropriate and timely intervention, the blood flow can be restored to the leg. Once this is established, the wounds/dying tissue can be healed. Additionally, surgical procedures can be performed to assist in restoring the flow; this can be achieved through endovascular procedures or by surgical bypass.

During an angioplasty procedure, a catheter with a small balloon is inserted into the vessel to open the artery and restore blood flow. If the artery continues to collapse, a stent can be placed inside the vessel to “hold” the vessel walls open and allow adequate flow.

Having uncontrolled diabetes puts one at extreme risk for vascular disease, and affects the ability of the body to heal wounds.  An infected wound can put a patient at risk, especially those with diabetes, who need to be very careful of infection.  It is recommended to check your feet daily for cuts or breaks in the skin and notify your physician of a problem immediately.