Critical Limb Ischemia (CLI)

Who is at risk?

Those who identify with any of the following risk factors:

• Smoking

• Diabetes

• High Blood Pressure

• High Cholesterol

• Kidney Disease

• Patients with known plaque buildup in other parts of the body, like the heart or neck, or a history of aneurysms.

Signs/Symptoms

Common symptoms in CLI patients include claudication (pain that occurs when walking or exercising and disappears at rest), pain at rest in the foot during the day or at night while sleeping, discoloration, numbness, tingling, or coldness in the lower legs and feet, ulcers/sores or gangrene on the legs or feet.

Diagnosis

• Your doctor will perform a complete patient history and physical exam and possibly order blood tests.

• Outpatient non-invasive vascular testing may include a combination of:

  • Ankle brachial index (ABI) and Toe brachial index (TBI). These are calculated using blood pressures from the arms and feet and toes at rest. An ABI < 0.90 and a TBI < 0.7 confirms the diagnosis of peripheral arterial disease.

  • Duplex ultrasound of the leg arteries.

  • Pressure and volume measurements of the blood flow in the legs (PVR, Segmental Pressures).

  • TcPO2/TCOM which measures the oxygen level of the tissues using sensors on the foot.

  • CT or MR Angiogram of the legs which are CT or MRI scans of the arteries in the legs using contrast injected into an arm vein.

Treatment

Depending on the location and severity of the blockages in the leg arteries and your risk factors, your doctor will help you with risk factor modification and prescribe medications, an exercise program, or recommend treatment.

Most vascular treatments are outpatient, non-surgical, performed with local anesthesia and light sedation medications, using a tiny nick in the skin the size of a pencil tip. Using a small artery in the groin, wrist, or foot, as well as various cameras to see inside the body, a small tube called a catheter is advanced through the blood vessels to the blocked artery. Then various devices allow doctors at FVS to shave/remove atherosclerotic plaque and fatty deposits as well as dilate narrowed and blocked arteries. In some instances when the blocked artery does not stay open with the above techniques, a scaffold called a stent may be necessary to keep the artery open thereby preventing surgery in most cases. Recovery is usually a few hours and rarely a one night hospital stay. Most patients have immediate improvement in their symptoms. Follow-up clinic visits are scheduled every few months to make sure symptoms are not recurring.