What Is Critical Limb Ischemia?

Critical limb ischemia (CLI) is a severe form of peripheral artery disease (PAD). In people with PAD, the arteries that supply blood to their limbs become narrow. This makes it harder for blood to reach their arms, legs, hands, and feet.^1,2

CLI is a serious condition in which the blood flow to the arms or legs becomes blocked. The arms, hands, legs, or feet may become painful or numb. Wounds or sores also can develop on the affected areas. In some cases, limb amputation is needed to surgically remove the affected area.^1-3

What causes CLI?

During PAD, plaque starts to build up in the arteries. This buildup makes the arteries narrow and stiff. PAD can affect arteries that supply blood to the arms, hands, legs, and feet. In most cases, it affects the blood flow to the legs and feet.¹

As PAD gets worse, plaque continues to build up in the arteries. Eventually, this can block blood flow. CLI occurs when certain parts of the limbs stop receiving enough blood.^1-3

Risk factors

Certain factors can increase the chances of developing CLI. These include:^3,4

• Diabetes
• High blood pressure
• High cholesterol
• Chronic kidney disease
• Older age
• Smoking

Symptoms of CLI

One common symptom of CLI is pain in the affected area. People may experience pain even when resting. People with CLI that affects the feet or legs may experience pain when walking or running.^1,3

They may also experience pain that gets worse when lying down. This is because blood flow slows down when lying flat. This can make it harder to sleep as well.^1,3

Other symptoms of CLI may include:^2-4

• Numbness in the limbs
• Cold hands, feet, or legs
• Wounds, ulcers, or open sores on the limbs
• Injuries that do not heal and become infected
• A weak pulse or no pulse in the legs or feet

Due to the lack of blood flow, any injuries on the affected areas heal very slowly or not at all. Over time, the injuries can turn into gangrene (dead tissue). If left untreated, the affected area may need to be amputated. CLI also increases the chances of having a heart attack or stroke.^1-4

Treatments for CLI

If you experience any symptoms of CLI, talk to your doctor immediately. Your doctor will use several tests and imaging techniques to see whether blood flow is blocked in your arms or legs.

Treatments for CLI mostly include procedures that allow blood to flow normally through the arteries. The treatments may include:^1,3

• Bypass surgery – This procedure involves placing another blood vessel near the blocked artery so that blood can flow around the blockage.
• Angioplasty – In this procedure, a surgeon uses a balloon or stent (a mesh tube made of metal) to make the arteries wider and allow blood to flow.
• Atherectomy – This procedure can be used to remove plaque buildup.
• Wound care – Your doctor will tell you the best ways to make sure any wounds in the affected area heal properly.

To decrease your chances of having a stroke or heart attack, your doctor may also prescribe drugs to treat:³

• High cholesterol
• High blood pressure
• High blood sugar

Prevention

You can reduce your chances of developing PAD and CLI by:^1-4

• Eating a healthy diet
• Increasing your physical activity
• Managing your blood pressure, cholesterol, and blood sugar through lifestyle changes or medicine
• Quitting smoking
• Reducing your stress levels

CLI is a severe complication of PAD, and it requires early treatment. If treatment is delayed, CLI can lead to infection. About 1 in 4 people with CLI require an amputation. If you have PAD, be on the lookout for any symptoms of CLI. This can help you detect CLI early and avoid the need for an amputation.^3,4