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Is Critical Limb Ischemia Life Threatening?

Critical limb ischemia can be life-threatening. The mortality rate at one year following diagnosis is 24%, and it rises to 60% at five years.
Critical limb ischemia can be life-threatening. The mortality rate at one year following diagnosis is 24%, and it rises to 60% at five years.

Critical limb ischemia is a severe blockage in the arteries of the lower extremities, which significantly reduces blood flow. It is an advanced form of peripheral arterial disease (PAD), a condition that affects blood vessels in the extremities. 

Critical limb ischemia is a chronic condition that results in severe pain in the feet or toes, even at rest, slow healing wounds, and tissue loss due to gangrene. 

Life Expectancy

Critical limb ischemia can be life-threatening.

  • The mortality rate at one year following diagnosis is 24%, and it rises to 60% at five years.
  • In fact, more people who have critical limb ischemia die within five years of diagnosis than with any type of cancer, except for lung cancer. 

What Are Symptoms of Critical Limb Ischemia?

Symptoms of critical limb ischemia include:

  • Severe pain in the legs and feet while a person is not moving (called ischemic rest pain)
  • Open sores, skin infections, or ulcers on the feet and legs that will not heal
  • Numbness in the feet
  • Shiny, smooth, dry skin of the legs or feet
  • Thickening of the toenails
  • Diminished or absent pulse in the legs or feet
  • Dry gangrene (dry, black skin) of the legs or feet

What Causes Critical Limb Ischemia?

Critical limb ischemia is an advanced stage of peripheral arterial disease (PAD), which is caused by the hardening and narrowing of the arteries over time due to the buildup of fatty deposits called plaque (by atherosclerosis).

Risk factors for chronic limb ischemia are the same as those for atherosclerosis, including:

How Is Critical Limb Ischemia Diagnosed?

Critical limb ischemia is diagnosed with a patient history and physical examination. The blockages associated with critical limb ischemia are located using one or more of the following methods:

What Is the Treatment for Critical Limb Ischemia?

Immediate treatment is needed for critical limb ischemia to re-establish blood flow to the affected area and to preserve the limb.

Treatments for critical limb ischemia include: 

  • Endovascular treatments
    • Angioplasty
      • A tiny balloon is inserted through a puncture in the groin and is inflated using a saline solution, to open the artery
        • Cutting balloon: The balloon is imbedded with micro-blades that cut the surface of the plaque, reducing the force necessary to dilate the vessel
        • Cold balloon (CryoPlasty): The balloon is inflated using nitrous oxide which freezes the plaque
    • Stents
      • Metal mesh tubes are used to provide scaffolding after an artery has been opened using a balloon angioplasty
        • Balloon-expanded: A balloon is use to expand the stent
        • Self-expanding: Compressed stents expand upon release
    • Laser atherectomy: the tip of a laser probe is used to vaporize small bits of plaque 
    • Directional atherectomy: A catheter with a rotating cutting blade physically removes plaque from the artery, opening the flow channel
  • Surgical treatments
    • Wounds or ulcers may require surgical procedures or other follow-up care
    • Surgical treatment may be recommended if endovascular therapy is not beneficial for the arterial blockages 
    • Often involves bypass around the diseased segment with either a vein from the patient or a synthetic graft
References
Image Source: iStock Images

https://health.ucdavis.edu/vascular/diseases/cli.html

https://evtoday.com/articles/2019-may/critical-limb-ischemia-a-threat-to-life-and-limb