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Critical Limb Ischemia

Critical limb ischemia (CLI) is a condition that can occur over time when leg arteries are damaged. It is a severe form of peripheral arterial disease (PAD). PAD is caused when leg arteries are narrowed, reducing blood flow. If blood flow to the toe, foot, or leg is completely blocked, the tissue begins to die (gangrene). If this happens, you need medical care right away to restore blood flow and possibly save the leg. But even with the best medical care, it might not be possible to save a severely affected limb

When do you need emergency care?

Sole of foot showing nonhealing ulcer on big toe and gangrene on first three toes.Critical limb ischemia can worsen and cause an urgent problem. For example, if you have a wound, it may not heal. This can lead to gangrene. Go to the emergency room right away if you have any of these symptoms:

  • You have a wound that is foul smelling, draining pus, or discolored. 

  • You have severe pain of the foot or leg that occurs suddenly without injury, especially if the foot or leg is cold or numb.

Call your doctor if:

  • You have a cut or ulcer that does not heal.

  • You have foot or leg pain that develops with walking but goes away with rest. This may be a sign of developing blockages.

How is critical limb ischemia diagnosed?

Certain tests may be done to find out if you have critical limb ischemia. First your doctor will carefully examine you, checking for pulses at several places. Other common tests include:

  • Ankle-brachial index (ABI). The blood pressure in the ankle is compared with the blood pressure in the arm.

  • Duplex ultrasound. Harmless sound waves are used to create images of blood flow in the legs.

  • Arteriography. X-ray dye (ontrast medium) is injected into the artery using a thin, flexible tube (catheter). This lets blood vessels to show up when X-rays are taken.

How is critical limb ischemia treated?

Possible treatments for critical limb ischemia include:

  • Dissolving or removing a blood clot. A catheter may be put into an artery in the groin to dissolve the clot. The catheter is then used to give “clot-busting” medicine. This dissolves the clot. Or surgery may be done to remove the clot. A cut (incision) is made in the artery at the blocked area. The clot is then removed.

  • Angioplasty. A tiny, uninflated balloon is sent to the narrowed area by catheter. It is then inflated to widen the artery. Finally the balloon is deflated and withdrawn.

  • Stenting. After angioplasty, a tiny wire mesh tube (stent) may be put in the artery to help hold it open. The stent is also delivered by a catheter.

  • Endarterectomy. An incision is made in the artery at the blocked area. The material that blocks the artery is then removed from artery walls.

  • Peripheral bypass surgery. A natural or artificial graft is used to bypass the blocked area.

  • Amputation. If left untreated, critical limb ischemia may lead to amputation of the affected area.

How can critical limb ischemia emergencies be prevented?

Know the signs and symptoms of a leg artery emergency. If you have diabetes or poor circulation, check your feet daily for wounds, sores, blisters, and color changes. If you smoke, stop smoking.


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