Chronic Critical Limb Ischemia 

What Is Critical Limb Ischemia?

Critical limb ischemia (CLI) is a severe reduction in blood flow to the legs and feet, causing oxygen and nutrient deprivation in the affected area. This can lead to severe complications, including pain, non-healing wounds, and tissue death.

The condition is caused by a buildup of plaque in the blood vessels, which can restrict blood flow to the legs and feet. Early diagnosis and treatment are important to prevent further complications and potentially prevent amputation.


Symptoms of Critical Limb Ischemia

This condition is characterized by severe foot and toe pain, but patients may also experience the following critical symptoms:

  • Coldness or numbness in the affected limb

  • Weakness or heaviness in the affected limb

  • Changes in skin color or texture, including darkening or ulceration

  • Slow-healing wounds or sores

  • Non-healing leg or foot ulcers

  • Restless leg syndrome

  • Tingling or burning sensations

  • Loss of hair on the affected limb

  • Decreased ability to exercise due to pain

These symptoms can indicate poor blood circulation to the feet and toes. Various underlying conditions, such as peripheral arterial disease and diabetes, also can cause this. If you experience these symptoms, it is essential to seek medical attention quickly.

What Are the Statistics on Critical Limb Ischemia?

Critical limb ischemia affects a significant number of people in the United States. CLI statistics, including the disorder’s prevalence and risk factors, can be useful in helping you understand this condition’s impact better and identify populations at higher risk. 


The exact prevalence of critical limb ischemia is difficult to determine, but some estimates suggest that it affects 200,000 and 500,000 people in the United States. According to the National Heart, Lung, and Blood Institute (NHLBI), the incidence of CLI is increasing, with a projected rise of 29% by 2030.

Risk Factors

The NHLBI estimates that about 80% of people with CLI have at least one of these risk factors. Several factors increase the risk of developing CLI, including advanced age, smoking, high blood pressure, high cholesterol, and diabetes. Other risk factors include peripheral arterial disease (PAD), obesity, and a sedentary lifestyle.


Critical limb ischemia can lead to severe complications, including non-healing wounds, gangrene, and amputation. According to the American Heart Association, amputation is required in about 20% of people with chronic critical leg ischemia.

In addition, people with CLI are at higher risk of cardiovascular events, such as coronary artery disease, heart attack, and stroke. They have a higher mortality rate than the general population.

How Is Critical Limb Ischemia Diagnosed?

Diagnosing CLI typically involves a physical examination and imaging tests such as angiography or duplex ultrasonography. Your doctor may also recommend blood tests to determine the oxygen level in your blood.

How to Treat Critical Limb Ischemia

Critical limb ischemia is a complex condition requiring a multi-disciplinary management approach. The treatment plan will depend on the underlying cause of the CLI, the disease’s severity, and the patient’s overall health.

Treatment options for CLI include percutaneous transluminal angioplasty (PTA), endovascular treatment, and blood pressure lowering. Randomized controlled trials have shown that PTA and endovascular treatment can effectively treat patients developing CLI.

The goal is to restore blood flow, prevent further damage to the affected limb, and reduce the risk of serious complications such as amputation. CLI treatments include the following:

Lifestyle Changes

Healthy lifestyle changes, such as quitting smoking, controlling high blood pressure and cholesterol levels, and maintaining a healthy weight, can help improve blood flow and reduce the risk of developing CLI.


Medications such as aspirin, clopidogrel, and cilostazol can improve blood circulation and reduce the risk of blood clots. In addition, drugs that control high blood pressure and cholesterol levels can also be prescribed.

Interventional Procedures

Interventional procedures, such as angioplasty and stenting, can improve blood flow by opening up blocked or narrowed blood vessels.

Surgical Procedures

In some cases, surgical procedures such as vascular surgery may be required to restore blood flow to the legs and feet.

Wound Care

Wound care, such as debridement and topical treatments, can help heal non-healing wounds. In some cases, advanced wound care treatments, such as hyperbaric oxygen therapy, may be necessary.

Endovascular Revascularization

Endovascular therapy is a minimally invasive procedure involving a catheter or other devices to treat peripheral artery disease and other conditions without surgery. The goal is to reduce the symptoms of peripheral vascular disease, such as pain and numbness, and improve quality of life.

Ongoing Therapy and Surveillance 

Ongoing monitoring of patients following endovascular revascularization usually involves a combination of approaches. These include regular follow-up appointments with healthcare providers to ensure the procedure was successful and monitor for potential complications or re-occurrence of symptoms.

Critical Limb Ischemia: When to Amputate

Major amputation is a last-resort treatment for severe ischemia. It is usually only recommended in cases where all other treatments have failed and the condition is likely to become life-threatening. The following factors may influence the decision to amputate:

  • Non-healing wounds may become infected and put the affected limb at risk of gangrene.
  • People with CLI may experience severe pain, particularly when walking or standing.
  • Gangrene may occur when the tissues in the affected limb die due to a lack of blood flow.

Amputation may be considered if the affected limb is causing significant pain, affecting mobility, and decreasing quality of life.

It is important to note that amputation is a significant decision that should be made in consultation with a doctor after all other treatment options have been exhausted. Amputation is a life-changing procedure, and rehabilitation and physical therapy are often necessary after the procedure to help the patient adjust and regain mobility.


Call Dr. Silva for a Consultation

Critical limb ischemia can significantly impact a person’s quality of life. Scheduling an appointment as soon as critical limb ischemia symptoms are detectable is wise.

As a dedicated Podiatrist in Santo Domingo, Dr. Silva is committed to providing optimal care for his clients. With his experience and commitment to providing timely, cost-effective, and excellent Services, he will work with you to find the right solution for your needs.

Frequently Asked Questions 

Below are answers to a few of the most commonly asked questions about CLI.

How Long Can One Live With Critical Limb Ischemia?

The lifespan of a person with CLI depends on various factors. The severity of the condition, overall health, and the effectiveness of treatment all play a part. Generally, however, the prognosis for people with CLI is not good, as the disease is associated with an increased risk of serious complications.

Is Critical Limb Ischemia Life-Threatening?

CLI can be potentially life-threatening if left untreated. As the condition progresses, it can develop serious complications. Infection spreading to the bloodstream can cause sepsis, which can be life-threatening.

Limb Ischemia: What Are the 6 Ps?

The 6 “P’s” of limb ischemia is a mnemonic used to describe the critical components of assessing and managing patients with CLI. The 6 P’s are:

  • Pain: Ongoing or intense discomfort

  • Pulse: Poor quality or lack of peripheral pulses in the affected limb

  • Pallor: Skin color changes indicating a lack of blood flow

  • Paresthesia: Tingling or burning sensation often described as “pins and needles”

  • Paralysis: Inability to move the affected limb

  • Poikilothermia: Temperature changes indicating impaired circulation