Dr. Jenny Gandhi

702, 7th Floor, Solaris Kode, Near Khatu Shyam Temple, VIP Road, Vesu , Surat.
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Critical Limb Ischemia

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Critical Limb Ischemia

+91 90033 03373

Critical Limb Ischemia

Home

Critical Limb Ischemia

WHAT IS
CRITICAL LIMB ISCHEMIA?

A severe, persistent blood shortage in the leg causes tissue death (gangrene), open sores (ulcers), or chronic pain at rest. If nothing is done, amputation might be required. Wound care and revascularization are part of the treatment.

causes

Advanced atherosclerosis
Smoking
Diabetes mellitus
High blood pressure
High cholesterol
Older age
Obesity
Family history
Chronic kidney disease

symptoms

Severe pain or cramping in the legs or feet
Non-healing sores, ulcers, or wounds on the feet
Skin changes such as shiny, dry, smooth, or pale skin on the legs or feet
Coldness or numbness in the affected limb
Weak or absent pulse in the legs or feet
Thickened toenails
Tissue death
Muscle loss or weakness in the affected limb

if untreated?

High risk of limb loss due to non-healing wounds, ulcers, or gangrene, often requiring amputation.
Progressive tissue damage and infection, further worsening the condition of the limb.
Increased risk of cardiovascular events such as heart attack and stroke, as CLI reflects widespread atherosclerosis.
High mortality rates, with about 25% of patients dying within one year and over 60% within five years, mainly from cardiovascular causes.
Significant functional impairment, reduced mobility, and decreased quality of life due to severe pain and tissue loss.
Increased healthcare costs and need for medical interventions such as surgery, rehabilitation, and long-term care.

diagnosis

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Physical Examination
  • Checking for absent or weak pulses in the legs or feet, skin changes (shiny, smooth, dry skin), muscle wasting, and presence of ulcers or gangrene.
Ankle-Brachial Index (ABI)
  • Measures the ratio of blood pressure in the ankle to the arm; ABI less than 0.4 suggests severe ischemia.
Toe Pressure Measurement
  • More accurate in patients with arterial calcification; toe pressures below 30 mm Hg indicate critical ischemia.
Transcutaneous Oxygen Pressure (TcPO2)
  • Measures oxygen delivery to tissues; low values indicate poor perfusion.
Doppler Ultrasound
  • Evaluates blood flow and detects blockages or narrowing in arteries.
  • CT Angiography (CTA) or MR Angiography (MRA): Provide detailed images of arterial blockages.
Conventional Angiography
  • Invasive but gold standard for definitive evaluation before intervention.
WIfI Classification System
  • Assesses the severity based on Wound, Ischemia, and foot Infection to guide treatment decisions.

Interventional Radiology
treatment

Angioplasty

The purpose of angioplasty is to restore blood flow, alleviate symptoms (such as claudication), and promote wound healing in ischemic limbs. A thin catheter with a small deflated balloon at its tip is guided to the narrowed peripheral artery under X-ray guidance, the balloon is inflated to compress plaque against the artery wall and widen the lumen, and the balloon is then deflated and removed.
Atherectomy

To remove the blockage, the plaque accumulation on the arterial walls is physically removed or shaved off using a catheter-based device. To increase vessel patency, atherectomy can be used either by itself or in conjunction with angioplasty, particularly for complex or highly calcified lesions.
Drug‑Eluting Balloon (DEB) Angioplasty

Compared to plain balloon angioplasty, drug-eluting balloon angioplasty is more effective in small distal vessels and in-stent restenosis because it lowers the risk of restenosis by coating the balloon surface with an anti-proliferative drug (usually paclitaxel or other agents) that is transferred to the vessel wall during inflation.

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