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Critical Limb Ischemia

Critical limb ischemia (CLI) is a condition that can occur over time when leg arteries are damaged. It is a severe form of peripheral arterial disease (PAD). PAD is caused when leg arteries are narrowed, reducing blood flow. If blood flow to the toe, foot, or leg is completely blocked, the tissue begins to die (gangrene). If this happens, you need medical care right away to restore blood flow and possibly save the leg. However, even with the best medical care, it might not be possible to save a severly affected limb.

Sole of foot showing gangrene on two toes and nonhealing ulcer at base of big toe.

When Do You Need Emergency Care?

Critical limb ischemia can worsen and cause an urgent problem. For example, if you have a wound, it may not heal. This can lead to gangrene. Go to the emergency room right away if you have any of the following symptoms:

  • You have a wound that is foul smelling, draining pus, or discolored. 

  • You have severe pain of the foot or leg that occurs suddenly without injury, especially if the foot or leg is cold or numb.

Call your doctor if:

  • You have a cut or ulcer that does not heal.

  • You have foot or leg pain that develops with walking but goes away with rest. This may be a sign of developing blockages.

How Is Critical Limb Ischemia Diagnosed?

Certain tests may be done to determine if you have critical limb ischemia. First, your doctor will carefully examine you, checking for pulses at several locations. Other common tests include:

  • Ankle-brachial index (ABI): The blood pressure in the ankle is compared to the blood pressure in the arm.

  • Duplex ultrasound: Harmless sound waves are used to create images of blood flow in the legs.

  • Arteriography: Contrast medium (X-ray dye) is injected into the artery using a catheter (thin, flexible tube). This allows blood vessels to show up when X-rays are taken.

How Is Critical Limb Ischemia Treated?

Possible treatments for critical limb ischemia include:

  • Dissolving or removing a blood clot: A catheter may be inserted into an artery in the groin to dissolve the clot. The catheter is then used to deliver “clot-busting” medication, which dissolves the clot. Or surgery may be done to remove the clot. An incision is made in the artery at the blocked area. The clot is then removed.

  • Angioplasty: A tiny, uninflated balloon is delivered to the narrowed area by catheter. It is then inflated to widen the artery. Finally, the balloon is deflated and withdrawn.

  • Stenting: After angioplasty, a stent (tiny wire mesh tube) may be placed in the artery to help hold it open. The stent is also delivered by a catheter.

  • Endarterectomy: An incision is made in the artery at the blocked area. The material that blocks the artery is then removed from artery walls.

  • Peripheral bypass surgery: A natural or artificial graft is used to bypass the blocked area.

  • Amputation: If left untreated, critical limb ischemia may lead to amputation of the affected area.

How Can Critical Limb Ischemia Emergencies Be Prevented?

Know the signs and symptoms of a leg artery emergency. If you have diabetes or poor circulation, check your feet daily for wounds, sores, blisters, and color changes. If you smoke, stop smoking.

Online Medical Reviewer: MMI board-certified, academically-affiliated clinician
Online Medical Reviewer: Turley, Ray, BSN, MSN
Last Review Date: 3/24/2014
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