Critical limb ischemia is a severe blockage in the arteries that significantly reduces blood flow to the lower extremities. It is considered the most serious form of peripheral artery disease (PAD) and results in severe pain in the toes and feet even while resting.
The reduced blood flow is caused by narrowing of the arteries or a blockage from a build-up of plaque which is composed of various substances that circulate in the blood.
Common symptoms of CLI include:
The criteria for a diagnosis of CLI includes either one of the following:
People with diabetes are at an increased risk of atherosclerosis (artery disease characterized by deposits of fatty materials on inner artery walls) and associated medical issues such as PAD and CLI. According to a study by the University of Rochester Medical Center, this is because of increased inflammation and decreased blood flow common in patients with the metabolic disorder.
Patients diagnosed with critical limb ischemia have to be treated immediately to re-establish blood flow to the affected areas. The main goal is to preserve the limb. If left untreated, serious complications can arise. Without proper blood flow to the legs and feet, gangrene (also known as tissue death) can occur. If the gangrene progresses and can't be dealt with, amputation may be the only viable option.
The type of treatments will depend on the severity of the condition and therefore may vary from person to person. Among the typical treatment options are:
Medications: Several therapeutics may be prescribed to prevent the progression of the disease and reduce the effect of contributing factors such as high blood pressure and diabetes.
Angioplasty: A thin tube called a catheter is inserted into the artery through a puncture in the groin. It is then guided to the site of the blockage. Once there, a small balloon is expanded using a saline solution that pushes the plaque outward to the artery's wall, which increases blood flow. Variations of angioplasty treatment include:
Cutting balloon angioplasty uses a special balloon tip with micro blades that are activated when the balloon is inflated. These cut the plaque surface, reducing the force required to dilate the blood vessel.
Cold balloon angioplasty (cryoplasty): Instead of a saline solution, the balloon is inflated with nitrous oxide. The gas freezes the plaque preventing it from growing.
Stents: Following an angioplasty, stents are put in place to keep the artery open. These are small metal tubes that serve as support for artery walls. Some may release medications to prevent future blockages.
Atherectomy: The plaque is either vaporized with a laser (laser atherectomy) positioned on the end of a catheter or shaved with tiny rotating blades that also sit on the end of a catheter (directional atherectomy).
Most of these minimally invasive endovascular treatments are done on an outpatient basis, and recovery takes one or two days.
If these treatments are not an option, such as when a plaque blockage is in an inaccessible area, surgery may be necessary. This typically involves a bypass around the diseased artery using a vein from the patient or a synthetic graft.
Treatment of critical limb ischemia also involves managing risk factors associated with atherosclerosis. This can include:
Call your doctor immediately if you have any symptoms of critical limb ischemia or think you may be suffering from the condition.
Here at the Midwest Institute for Non-Surgical Therapy (MINT), we provide state-of-the-art endovascular treatments for CLI and peripheral artery disease. Call us on 314-269-0946 or use our online booking service today to schedule a free vascular screening or consultation. We'll be able to see you in one of our convenient locations in the St Louis area.