Critical Limb Ischemia (CLI): Causes, Symptoms, Diagnosis, and Treatment

What Is Critical limb ischemia?

Critical limb ischemia (CLI), or chronic limb-threatening ischemia, is a condition in which the arteries in your lower limbs or legs are severely blocked, resulting in decreased blood flow to your limbs. It is considered a severe form of peripheral artery disease (PAD). PAD occurs when fatty deposits called plaque build up in your arteries, which can cause them to narrow or thicken. This results in reduced blood flow.

CLI is a chronic condition that causes intense pain even at rest. Due to the limited blood supply, wounds or sores may fail to heal for a long time. And a poor blood supply will weaken and damage tissues and muscles. If not treated, it may lead to heart issues, limb amputation, or even death.

What Are the Signs and Symptoms of Critical Limb Ischemia?

The critical limb ischemia symptoms include -

• Intense pain in your legs, even when you are at rest (rest pain).

• Non-healing ulcers.

• The skin on your legs would appear smooth, dry, or lustrous.

• You may notice a weak or absent pulse in your legs or feet.

• Thickening of your toenails.

• Color changes in your skin.

• Discharge from gangrene (tissue death due to poor blood supply).

• You might notice numbness in your feet or legs.

What Causes Chronic Limb Ischemia?

Chronic limb ischemia is usually caused by narrowed or blocked arteries in your lower extremities. The narrowing of arteries occurs due to atherosclerosis, where fatty deposits called plaque build up on the walls of arteries.

You are at risk of developing CLI if you have any of the following -

1. Smoking.

2. Diabetes.

3. High blood pressure.

4. High cholesterol.

5. Older age.

6. Obesity or lack of exercise.

7. Family history of artery disease.

How Is Critical Limb Ischemia Diagnosed?

Critical limb ischemia diagnosis is often made with the help of your symptoms and with physical examination by your treating doctor. Your doctor may also use certain tests to diagnose the condition, which include -

1. Ankle-Brachial Index (ABI) - With this index, blood pressure in your legs and arms is compared to check how well the blood flows in your arteries.

2. Doppler Ultrasound - This helps in determining the speed and the direction in which the blood flows in your arteries.

3. CT (Computed Tomography) Angiography - This is an advanced procedure that provides three-dimensional (3D) images of your arteries with the help of a computer.

4. Angiogram - It helps to detect the block in your arteries by using contrast dyes.

5. Auscultation - Your doctor uses a stethoscope to hear the whooshing sound in your arteries and figure out any abnormality.

6. MR (Magnetic Resonance) Angiography - This imaging technique involves using radiofrequency waves in a strong magnetic field. It creates two or three-dimensional images of your leg arteries.

How Is Critical Limb Ischemia Treated?

Critical limb ischemia is a harmful condition that requires immediate treatment to restore blood flow in your limbs. The main goal of treatment is to protect the limbs and prevent limb amputation. The treatment includes the following -

Endovascular (Minimally Invasive) Treatments:

Many people with CLI can be treated with minimally invasive procedures like endovascular treatment that involve tiny groin punctures performed under local anesthetic. To access the blocked area, a small tube known as a catheter is placed into the artery. Depending on the kind and location of the obstruction, several techniques may be employed:

1. Angioplasty - During this procedure, a tiny balloon is inserted into the puncture in the groin, and the balloon is dilated multiple times using saline solution to open your blocked or narrowed arteries in the leg.

• Cutting Balloon - In this method, a balloon with microcutting blades is used to dilate the narrowed arteries. The microblades in the balloon cut the plaque deposits on the wall of the arteries, reducing the effort required to widen the arteries.

• Cryoplasty - During this procedure, instead of saline solution, a balloon is inflated using nitrous oxide, which freezes the plaque. This slows down the deposition of plaque in the arteries and reduces scarring.

2. Stents - Following widening of the artery using balloon angioplasty, metal mesh tubes are placed that serve as support structures and are left in place. It includes two types -

• Balloon-Expanding Stents: The stents are expanded using balloons. These stents are stronger but are less flexible.

• Self-Expanding Stents: These stents are more flexible and are compressed while positioning and expand themselves after release.

3. Laser Atherectomy: In this procedure, a laser tip is used to vaporize small pieces of plaque.

4. Directional Atherectomy: This procedure involves using a catheter with a revolving blade to cut the plaque inside the arteries and open the narrowed arteries.

Surgery:

Sometimes, the blockages cannot be treated with minimally invasive procedures. In such cases, surgery is needed. Vascular bypass surgery usually involves bypassing the blocked artery using either a vein from the patient’s body or a synthetic graft.

• Hospital stay after bypass surgery can range from a few days to over a week.

• Full recovery may take several weeks.

• Surgery may also be needed to treat wounds or ulcers on the legs or feet.

How to Prevent Chronic Limb-Threatening Ischemia?

CLI is caused by the buildup of fatty deposits in the artery walls. So prevention should focus on maintaining the health of the arteries without disrupting the blood flow.

1. Avoid smoking, as smoking damages the arteries and increases fat buildup.

2. Engage in regular exercise as it can improve blood flow and muscle strength.

3. Maintain your weight according to your age, sex, and height.

4. Control chronic conditions like diabetes, as they can damage your blood vessels.

5. Maintain your blood pressure (BP), since high BP can cause excess pressure on your arteries. Take your doctor’s advice to keep it under control.

6. Decrease your cholesterol level if it is high using medication or making lifestyle changes.

7. Check your feet regularly for any sores or ulcers.

8. If you have any other cardiac issues or have a history of stroke, consult a doctor, as these can decrease the blood flow.

Conclusion

Chronic limb ischemia is a condition where the blood vessels are blocked or narrowed by fatty deposits, resulting in poor blood supply to the limbs. The primary CLI symptoms are intense pain even at rest and non-healing sores or ulcers. CLI treatment includes minimally invasive procedures and surgery. If you or your loved ones notice any symptoms related to CLI, get expert GP (general practitioner) advice online to make a definitive diagnosis and for a tailored treatment plan.

Key Takeaways:

• Chronic limb ischemia is a peripheral artery disease where the arteries are blocked, resulting in reduced blood flow to your limbs.

• Treatment includes endovascular procedures like balloon angioplasty, direct arthrectomy, and surgical procedures like bypass grafting.

• If you notice any symptoms related to CLI, consult our general practitioners online at iCliniq to help manage your symptoms and treat the condition.