Critical limb ischemia (CLI) is a serious obstruction in the arteries of the lower limbs that lowers blood flow significantly. It is a severe type of peripheral arterial disease (PAD), however it is less prevalent than claudication. PAD is caused by atherosclerosis, which is the gradual hardening and constriction of the arteries that occurs as a result of fatty deposits known as plaque.
CLI is a persistent illness that causes extreme discomfort in the feet or toes even while lying down. Poor circulation can lead to ulcers and wounds that do not heal in the legs and feet. If CLI problems are not addressed, the damaged limb will be amputated.
When it comes to this condition, the most common question asked was about its severity. Critical limb ischemia raises your chances of serious health issues including death. Within one year of being diagnosed with critical limb ischemia: Amputations affect about one in every three persons and one in every four persons dies, most usually from heart disease or a stroke.
Who is at risk of critical limb ischemia?
Anyone with PAD is at risk of developing critical limb ischemia. As you become older, your chances of developing the condition increases.
Other risk factors includes:
- Chronic kidney disease
- Blood pressure is high (hypertension).
- High cholesterol (hyperlipidemia).
- Tobacco smoking and use of other tobacco products
- Obesity or being overweight
- Sedentary way of life
- Atherosclerosis or claudication in the family
Symptoms of CLI (Critical Limb Ischemia)
An acute foot or leg pain is the most typical indication of persistent limb-threatening ischemia. This discomfort frequently wakes you up at night. Some persons might not experience discomfort but do have the following symptoms:
- Hands, feet, or legs that are cold.
- Feet that are smooth, glossy, hairless, or very dry.
- Weak or non-existent pulse in your legs or feet.
- You may have numbness in your legs, feet, or hands.
- Sores on your feet or legs that take a long time to heal.
- Skin darkening or discharge caused by gangrene.
- Toes with thick nails
Causes of CLI
The major cause of Critical Limb Ischemia is induced by peripheral artery disease. It occurs when arteries get constricted or obstructed over a period of months or years.
Though it is a serious condition, you can even lower the risk by seeking therapy for PAD, you can avoid persistent limb ischemia. You may also lower your risk factors by doing the following:
- Obtaining and maintaining an ideal weight for your age, and body type.
- Regular exercise that includes strength training, flexibility, and cardiovascular activities.
- Maintaining good blood pressure and cholesterol levels.
- Taking care of any co-existing diseases, such as diabetes
- Stress reduction through healthy coping skills such as meditation or talk therapy.
Diagnosis – Critical Limb Ischemia
Based on your symptoms and other medical issues, your doctor may suspect critical limb ischemia. Your doctor may use one or more of the following approaches to detect and determine the source of blockages associated with critical limb ischemia (CLI):
- Auscultation: Using a stethoscope, the doctor will listen for a popping sound in the arteries of the legs.
- Ankle-brachial index (ABI): This index value is calculated by dividing the blood pressure systolic of the arm by the systolic blood pressure of the ankle.
- Doppler ultrasonography is used to identify the direction and velocity of blood flow in arteries.
- CT angiography: A computer creates 3-D pictures of the vessels in this procedure.
- Magnetic resonance angiography (MR angiography): A magnetic field is utilized to create 2-D and 3-D pictures of blood arteries in this examination.
- Angiogram: A contrast dye is used in this test to acquire X-rays of the blood arteries.
Treatment for Critical Limb Ischemia
Critical limb ischemia is a life threatening condition that needs rapid medical attention to restore blood flow to the afflicted region. The first priority is to save the limb. There are two types of CLI treatment:
In the treatment of CLI, minimally invasive endovascular treatment is frequently a possibility. The Vascular Center offers a broad range of endovascular procedures. The suggested therapy is determined on the area and intensity of the blockages. The majority of CLI patients have numerous artery blockages, including those below the knee. In general, a groin puncture with local anesthetic and catheter insertion into the groin artery will give access to the diseased section of the artery. Endovascular techniques used to treat CLI include the following:
1.Angioplasty: A small balloon is implanted through a groin puncture. To expand the artery, the balloon must be inflated one or more times with a saline solution.
a)Cutting balloon: To dilate the diseased region, a balloon embedded with micro-blades is employed. The blades cut the plaque’s surface, lowering the force required to dilate the artery.
b)Cold balloon (CryoPlasty): Instead of saline, nitrous oxide is used to expand the balloon. The gas causes the plaque to freeze. The operation is gentler on the artery, the plaque’s development is slowed, and less scar tissue is formed.
2.Stents are thin metal tubes that are left in place just after an arterial has indeed been opened by a balloon angioplasty.
a)Balloon-expanded: The stent is enlarged using a balloon. These stents are more durable yet less flexible.
b)Self-expanded: Compressed stents are given to the sick location and self-expand. When they are released, they grow. These stents are more versatile.
3.Laser Atherectomy: A laser probe is used to melt plaque during laser atherectomy.
4.Directional Atherectomy: A spinning cutting blade linked to a catheter is used to remove plaque during directional atherectomy. These operations are often conducted as standard therapy and require one to two days.
When endovascular therapies are not an option, the doctor may recommend surgical procedures. In this case, the surgeon will use a vein or synthetic graft to eliminate or bypass the arterial disease. In rare cases, the surgeon may cut open the artery and remove the plaque, restoring the artery’s function. The patient may need to stay in the hospital for a few days to a week, and recuperation will take many weeks.
Among these two, Endovascular Treatment is known to be the most effective way of procedure to treat Critical Limb Ischemia with no side effects. Dr. Abhilash Sandhyala is a well-known Interventional radiologist, varicose veins expert in Hyderabad, and the top endovascular surgeon. His objective is to deliver high-quality, tailored healthcare. We have established a practice in which we have faith. Just click here for more information or to book an appointment, or just dial us.