Critical limb ischemia (CLI) is a severe obstruction in the arteries of the hands, feet, or legs that reduces blood flow to those areas.
- Ischemic rest pain: Rest pain is a burning pain in the ball of the foot and toes that can cause you to wake up in the middle of the night. Sleep can exacerbate the pain due to a lack of gravity-assisted blood flow to the foot, as it is the farthest from the heart and arteries. Patients who keep their legs straight during sleep may often have swelling of the feet and ankles. Hanging your legs over the edge of the bed or walking around can relieve rest pain.
- Non-healing sores: Non-healing sores are usually caused by injury or ill-fitting shoes and fail to respond to 4-12 weeks of treatment, including regularly dressing the sores, avoiding trauma, treating infection, and scraping dead tissue.
- Gangrene: Gangrene develops on the toes when blood supply is so low that the tissues in the legs, feet, and hands die due to a lack of oxygen.
Other symptoms of CLI include:
When to see a doctor
If you experience leg pain and numbness, seek medical help instead of dismissing it as a part of aging. The following people should undergo screening even if they have no symptoms of critical limb ischemia:
What causes critical limb ischemia?
Atherosclerosis is the main cause of critical limb ischemia. Atherosclerosis is a condition in which plaques form on the arteries, leading to reduced blood supply.
Although atherosclerosis usually develops in the blood vessels of the heart, the disease can also affect arteries in other parts of the body. When atherosclerosis obstructs blood flow to the lower extremities, this condition is called critical limb ischemia.
Other causes of CLI may include:
- Blood vessel inflammation
- Injury to legs
- Radiation exposure
- Problems in the structures of ligaments and muscles
How is critical limb ischemia treated?
Risk factor modifications can help reduce the symptoms of critical limb ischemia:
- Smoking cessation
- Blood pressure control
- Reduction of cholesterol level
- Controlling blood sugar level
- Reducing weight
- Regular physical exam
Medications administered to control CLI include:
- Cholesterol-lowering medications
- Hypertensive medications
- Anticoagulants or blood thinners
Surgical options to treat CLI include:
- Bypass surgery
- Thrombolytic therapy
Critical limb ischemia should be treated immediately. If pain medications fail to respond after 4-8 weeks of therapy, your doctor may suggest surgery or amputation. If non-healing sores or gangrene reveal the presence of infection, your doctor may prescribe antibiotic therapy or surgical scraping of dead tissues in the wound.
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Mayo Clinic. Peripheral artery disease (PAD). https://www.mayoclinic.org/diseases-conditions/peripheral-artery-disease/diagnosis-treatment/drc-20350563
Santilli JD, Santilli SM. Chronic Critical Limb Ischemia: Diagnosis, Treatment and Prognosis. Am Fam Physician. 1999 Apr 1;59(7):1899-1908. https://www.aafp.org/afp/1999/0401/p1899.html
The Regents of the University of California. Critical Limb Ischemia (CLI). https://surgery.ucsf.edu/conditions--procedures/critical-limb-ischemia.aspx
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