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Critical limb ischemia

Critical limb ischemia is a severe blockage in the arteries of the legs or feet that greatly reduces blood flow. Resulting in severe pain in the feet or toes, critical limb ischemia is a form of peripheral artery disease, caused by the narrowing of the arteries over time due to plaque buildup. It’s important to treat this condition before it advances to the stage where amputation of the affected limb is required for survival.

Symptoms

Symptoms and warning signs of critical limb ischemia include:

  • Pain or numbness in the feet while not moving. Pain can be relieved temporarily by hanging the leg over the bed or getting up to walk around.
  • A noticeable decrease in the temperature of your lower leg or foot compared to the rest of your body.
  • Shiny, smooth, dry skin of the legs or feet.
  • Thickening of the toenails.
  • Absent or diminished pulse in the legs or feet.
  • Toe or foot sores, skin infections or ulcers that will not heal.
  • Gangrene (dry, black skin) of the legs or feet.

Risk Factors 

The risk factors for critical limb ischemia include:

  • Age (Men over 60 and women after menopause)
  • Diabetes
  • Family history of cardiovascular disease
  • High blood pressure
  • High cholesterol
  • Obesity
  • Sedentary lifestyle
  • Smoking

Diagnosis

Your doctor may identify the cause of blockages associated with critical limb ischemia using one or more of the following methods:

  • Ankle-brachial index (ABI) – A test to measure blood pressure in the legs.
  • Doppler Ultrasound – A form of ultrasound that measures the direction and velocity of blood-flow through the vessels.
  • CT angiography – An advanced X-ray procedure that generates three-dimensional images.
  • Magnetic resonance angiography (MR angiography) – Radiofrequency waves that create two- and three-dimensional images of the blood vessels.
  • Angiogram – An X-ray study of the blood vessels using contrast dyes.

Treatment

Treatment of ischemia depends on its location and severity. However, for all forms of critical limb ischemia, controlling risk factors, especially quitting smoking, is essential to prevent progression of the ischemia and to save your limb or your life.

Treatment of critical limb ischemia is focused on getting more blood supply to the affected area. This may be accomplished several ways:

Medications

Medications may be prescribed to prevent further progression of the disease and to reduce the effect of contributing factors such as high blood pressure and cholesterol. Medications that fight infections and pain medications may also be prescribed in certain cases.

Exercise

Your doctor may prescribe an exercise routine. In addition to improving blood flow, regular exercise may result in other benefits such as weight loss, lower blood pressure, lower cholesterol, and better control of diabetes.

Endovascular Procedures

Endovascular treatments are minimally invasive procedures that use a thin, long tube called a catheter to unblock the artery.

  • Balloon angioplasty uses a balloon inserted with a catheter to open up the blocked artery. The balloon is inflated one or more times with a saline solution to open the artery.
    • A cutting balloon is imbedded with micro-blades to cut the surface of the plaque, reducing the force necessary to dilate the vessel.
    • A cold balloon (cryoplasty) is inflated using nitrous oxide instead of saline to freeze the plaque. This procedure is easier on the artery while generating little scar tissue.
  • Stents are metal mesh tubes that are left in place to serve as scaffolding to keep the artery open after using balloon angioplasty. A stent may be expanded by using a balloon or may be self-expanding.
  • Laser atherectomy uses the tip of a laser probe to vaporizesmall bits of plaque.
  • Directional atherectomy uses a catheter with a rotating cutting blade to physically remove plaque from the artery, opening the flow channel.

Surgical Treatments

Treatment of wounds or ulcers may require additional surgical procedures or other follow-up care. If the arterial blockages are not favorable for endovascular therapy, surgical treatment is often recommended.

  • Bypass surgery involves either a segment of leg vein or an artificial tube attached surgically above and below the blockage to detour blood flow, allowing blood to reach the area of beyond the blockage. Examples of bypass procedures are leg artery bypass or coronary artery bypass grafting (also known as open heart surgery). Hospitalization after a bypass operation varies from a few days to more than a week. Recovery from surgery may take several weeks.

The Orlando Health Heart Institute has physicians skilled in the latest procedures and technology to effectively diagnose and treat all forms of cardiovascular and vascular disease, including critical limb ischemia and peripheral artery disease. To schedule an appointment with the Critical Limb Ischemia team, call (321) 843-9199.