Understanding Critical Limb Ischemia

Patients with Peripheral Artery Disease must be aware of a condition known as critical limb ischemia (CLI), along with the American Heart Association's guidelines for diagnosing and treating this condition.

Understanding Critical Limb Ischemia

If you have CLI, that means arteries in your lower extremities are severely blocked. This serious form of peripheral artery disease dramatically reduces blood flow to the lower limbs and is the result of plaque buildup that leads to atherosclerosis, a narrowing and hardening of the arteries.

Critical limb ischemia is a chronic condition that causes foot and/or toe pain, even when you're at rest. If allowed to advance, CLI could cause ulcers to form on your legs or feet, and could even lead to limb amputation.

CLI Symptoms

CLI symptoms include:

• Ischemic rest pain (discomfort in the legs and feet upon completion of movement)
• Foot and leg ulcers
• Foot pain and numbness
• Shiny, dry and smooth foot and leg skin
• Toenail thickening
• Reduced foot and leg pulse
• Gangrene (dry, black skin) on the legs or feet 

Chronic Limb Ischemia: Diagnosis and Treatment

According to the American Heart Association's past president and director, Mark A. Creager, MD, "Timely diagnosis and treatment (of Chronic Limb Ischemia) is likely to preserve limb viability and improve quality of life." And that's because, while CLI affects approximately 12 million Americans, it's a tough condition to diagnose and manage. As such, it's crucial to evaluate limb perfusion, so that you can speed up the process of diagnosing CLI.

Updated Management Guidelines

Currently, doctors are told to observe at least two weeks of ischemic rest pain, ulcers, or gangrene before diagnosing CLI. You would also need to have reduced blood flow (hypoperfusion), a concern that can be detected with an ankle-brachial index (ABI), ankle pressure, toe-brachial index (TBI), toe systolic pressure, transcutaneous oximetry (TcPo2), or a skin perfusion pressure (SPP) test.

In the past, vascular specialists mostly relied on the (ABI) to detect chronic Iimb ischemia. But recently updated guidelines from the American Heart Association suggest that diagnoses may be more accurate when based on measured toe pressure.

Interestingly, the AHA also suggests using arterial doppler ultrasound to monitor blood flow, something we can do in our Georgia vascular clinic. So request a consultation today, and we can help you manage your arterial health to prevent CLI or deliver an earlier diagnosis.