Dr Abhilash

CRITICAL LIMB ISCHEMIA

Critical Limb Ischemia

Dr. Abhilash Sandhyala > Critical limb ischemia

Critical Limb Ischemia is the blockage of blood in the arteries, which reduces the blood flow to the extremities including hands, feet and legs.

Symptoms of Critical Limb Ischemia

  • Severe pain or numbness in the legs
  • Sores and ulcers in the feet, infections
  • Shiny, smooth, dry, black skin on the legs
  • Reduced pulse in the legs
  • Thickening of toenails

Causes of Critical Limb Ischemia

CLI is a serious condition of peripheral arterial disease ( PAD), which occurs due to thickening and narrowing of arteries due to the build up of plaque. This will reduce the circulation of blood in the legs, feet and hands.

Risk of Critical Limb Ischemia

The following factors put a person to risk:

  • Age
  • Smoking
  • Diabetes
  • Overweight or obesity
  • Inactive lifestyle
  • High cholesterol
  • High blood pressure
  • Family history of vascular disease

Diagnosis Critical Limb Ischemia

The doctor will carry out a physical exam; further tests can be carried out.

  • Auscultation:The doctor will use a stethoscope to hear a whooshing sound in the arteries of the legs.
  • Ankle-brachial index (ABI):To obtain this index value, the systolic blood pressure of the arm is divided by the systolic pressure of the ankle.
  • Doppler ultrasound: This is carried out to determine the direction and velocity of blood flow in the vessels.
  • CT angiography: In this, the computer generates 3-D images of the vessels.
  • Magnetic resonance angiography (MR angiography): In this test, magnetic field is used to develop 2-D and 3-D images of blood vessels.
  • Angiogram:In this test, contrast dye is used to take X-rays of the blood vessels.

Treatment Critical Limb Ischemia

There are two kinds of treatment for CLI:

  • Endovascular treatment:This is a minimally invasive treatment in which local anaesthesia is given. Then, a catheter is inserted in the groin which is passed to the affected part of the artery. Some procedures under endovascular treatment are as follows:
  • Angioplasty: The catheter inserted in the artery will have a tiny balloon attached to its end, which is inflated with saline solution once it reaches the affected part of the artery.
    • Cutting balloon: The balloon will have micro-blades which will shave the plaque, this will widen the vessel.
    • Cold balloon (Cryoplasty): The balloon is filled with nitrous oxide which will put an end to the growth of plaque, the scar tissue gets generated.
  • Stents: They are metal mesh tubes which are left in place after performing balloon angioplasty. They are two types of stents.
    • Balloon-expanded: A balloon is used to widen the stent; the stents are strong but less elastic.
    • Self-expanding: Stents placed at the site expand when they are released, they are elastic.
  • Laser atherectomy: A laser probe is used to vaporize plaque.
  • Directional atherectomy: A rotating cutting blade attached to the catheter is used to remove the plaque.Generally, performed on outpatient basis, these procedures take one to two days.

2. Surgical treatments

For people who are not suitable for endovascular treatments, the doctor would suggest surgical treatments. In this, the surgeon will remove or bypass the arterial disease with a vein or synthetic graft. Rarely, the surgeon might cut open the artery and remove the plaque restoring the artery in the body. The patient might require staying in hospital for a few days to more than a week, recovery will take some weeks.

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