Critical Limb Ischemia

Critical limb ischaemia is the most severe form of peripheral artery disease (PAD) and is characterised by persistent artery occlusions in the lower limbs, leading to a dramatic reduction in blood flow. Unlike milder claudication, patients have prolonged rest pain, non-healing sores, or gangrene. Without treatment, CLI can result in severe amputation in up to 40% of cases within one year.

Causes and Risk Factors

Atherosclerosis is the main cause of CLI, where arteries get narrowed due to plaque deposition; the condition is commonly exacerbated by diabetes, smoking, hypertension, and hyperlipidaemia. These variables lead to rapid blockage of the vasculature and impaired tissue perfusion. In India, the growing prevalence of diabetes is increasing the incidence of CLI among middle-aged adults.
Symptoms hallmark. Intractable foot discomfort at rest, not eased by elevation. Cool skin, hair loss, cyanosis. More advanced indications include punched-out sores on toes or gangrenous digits, indicating tissue necrosis.

Definition
Clinicians confirm occlusion and plan revascularisation with ankle brachial index (ABI < 0.4), doppler ultrasonography, angiography, or CT angiography. Multidisciplinary evaluation assesses comorbidities for best therapy.

Treatment Choices

Initial care is antiplatelets (aspirin/clopidogrel), statins, glycaemic control, and smoking cessation to arrest development. Endovascular interventions, like angioplasty, stenting, or atherectomy, restore flow with little invasiveness. If endovascular fails, surgical bypass or, rarely, amputation is next. Emerging stem cell therapies are promising. Sometimes prostacyclin analogues, such as iloprost, can help relieve discomfort and heal ulcers.