CLI) Critical limb ischemia is a serious condition brought on by inadequate blood flow to some parts of the body. It is a severe form of peripheral arterial disease (PAD) and is usually the result of a blockage of the arteries, the vessels that supply blood to the body.
Critical limb ischemia can occur anywhere blood flows but is most common in the legs and feet. According to studies, around 1% of the US adult population above 40 has CLI. The condition will not improve on its own and, left untreated, can result in amputation of the affected limb.
Critical Limb Ischemia Symptoms
The most prominent feature of CLI is severe pain or burning sensation in the legs and feet. It is known as rest pain because it happens when a person is resting even while they're asleep. The pain can be more severe when the feet are elevated; however, you can obtain some relief by walking or temporarily dangling your leg over your bed. This is because gravity pulls on the blood, helping it to flow.
Other common symptoms of CLU include:
- Open sores, ulcers or skin infections that do not heal or heal very slowly
- The skin turns pale and smooth and may also be shiny and dry
- Loss of muscle mass in the legs
- Gangrene of the legs or feet. This is where the loss of blood flow causes tissue to die
- Severely reduced pulse in the legs or feet
- The affected limb is colder than the rest of the body
- Thick toenails on the affected limb
- Shortness of breath
- Swelling in the legs and feet
Critical Limb Ischemia Risk Factors
The common risk factors for critical limb ischemia in addition to having diabetes are smoking, high blood pressure, a history of atherosclerosis (narrowing and hardening of arteries due to a build-up of plaque) and having a sedentary lifestyle.
How Is Critical Limb Ischemia Diagnosed?
Your doctor may use any of several methods to determine whether or not you have CLI, including:
1) Using a stethoscope to listen for a whooshing sound in the leg arteries. This is an abnormal sound or murmur indicating turbulent blood flow possibly caused by an obstruction in an artery.
2) Ultrasound to study blood flow and find blocked arteries.
3) Ankle-brachial index, which is a simple test that compares the blood pressure in the arms and legs.
4) Magnetic resonance angiography (MR angiography). This is similar to magnetic resonance imaging or MRI but for blood vessels. Patients lie flat inside a magnetic resonance imaging scanner while radio waves and a computer create a blood vessel scan.
5) An angiogram. Special dyes are injected into the blood so blood vessels can be seen under x-rays, allowing doctors to spot any problems.
Treatment for Critical Limb Ischemia
If CLI is diagnosed, immediate treatment is required to reestablish blood flow. The type of treatment depends on the severity of the condition and can include:
Some medications may be prescribed to reduce contributory factors such as high blood pressure and prevent the progression of the disease.
Minimally invasive treatments to increase blood flow to the affected areas. These can include:
Angioplasty - a very small balloon is inserted through a puncture in the groin and inflated with a saline solution that has the effect of widening the artery.
Atherectomy - using a catheter with a sharp blade to remove plaque. In laser atherectomy, a tip of a laser probe vaporizes small bits of plaque.
Stents - once an artery has been opened, metal mesh tubes are left in place to keep it open.
If CLI has advanced to such a stage where endovascular treatments are not possible, surgery is often recommended. This involves reestablishing blood flow with an artificial tube or vein from the patient's body to route blood flow around the damaged artery to the affected area.
In some cases, an amputation below the knee may be required.
How to Avoid Critical Limb Ischemia
If you have PAD, you are at increased risk of developing critical limb ischemia. Therefore doctors recommend taking proactive steps to lower risk factors. These include:
- Stopping smoking
- Losing weight
- Lowering cholesterol. For example, by adding more Omega 3 foods in your diet and cutting down on saturated fats.
- Keeping your diabetes under control through diet, exercise and prescribed medications
- Moving more
- Lowering blood pressure. For example, by reducing stress and lowering salt and alcohol intake.
If you think you are developing symptoms of chronic limb ischemia, call your doctor or a vein/artery specialist immediately.
Here at the Midwest Institute for Non-Surgical Treatment (MINT), Dr. Goke Akiinwande is a vascular specialist skilled at opening arteries and veins to increase blood flow and prevent amputations. To schedule a FREE vascular consultation, call us on 314-269-0946 or use our online booking service today to visit one of our 5 clinics, including the latest addition in Chicago, IL.