Critical Limb Ischemia

Critical limb ischemia is a serious form of peripheral arterial disease (PAD) characterized by severe blockage in the arteries of the lower extremities that can significantly reduce blood-flow. Such poor blood flow can cause severe pain in the legs and feet when a person is not moving, or lead to non-healing sores on the feet or legs. Immediate treatment can help re-establish blood-flow to the affected area. Left untreated, critical limb ischemia could make it necessary to amputate the affected limb.

The most common signs of critical limb ischemia include:

  • Pain or numbness in the feet.
  • Shiny, smooth, dry skin of the legs or feet.
  • Thickening of the toenails.
  • Absent or diminished pulse in the legs or feet.
  • Open sores, skin infections or ulcers that will not heal.
  • Dry gangrene (dry, black skin) of the legs or feet.

In general, the goal of any treatment plan is to improve blood flow, reduce the pain, and save the limb (leg).

The George Washington University Hospital performs minimally invasive endovascular procedures to help restore oxygenated blood flow to the affected areas of skin. Treatment depends on the location and severity of the blockages.

Most patients have multiple arterial blockages, including blockages of the arteries below the knee. To access the arteries, physicians insert a catheter, under local anesthesia, into the groin to access to the diseased portion of the artery.

Various tools and techniques can be used to clear the artery or bypass the artery, such as:

  • Angioplasty: A tiny balloon is inserted through the catheter. When the balloon reaches the site of the blockage, it is inflated and deflated to open the artery.
  • Cutting balloon: A balloon with micro-blades is used to cut the surface of the plaque, improving blood flow.
  • Cold balloon (CryoPlasty): A balloon is inflated using nitrous oxide to freeze the plaque.
  • Stents: Different types of metal stents may be inserted into the artery through the catheter and left in place to provide support to vessel walls.
  • Balloon-expanded: A balloon is use to expand the stent. These stents are stronger but less flexible than self-expanding stents.
  • Self-expanding: Compressed stents are delivered to the diseased site. They expand upon release. These stents are more flexible than balloon-expanded stents.
  • Laser atherectomy: The tip of a laser probe is used to vaporize small bits of plaque.
  • Directional Rotational atherectomy: A catheter with a rotating cutting blade is used to remove plaque from the artery.

Recovery from these procedures usually takes one or two days, and most of these procedures are done on an outpatient basis.

Surgical treatments

In some cases a bypass graft may be performed. This surgical procedure uses either an artificial tube or a vein from the patient’s body as a new artery to bring improved blood flow to the needed area, bypassing the spot where blood flow is constricted. In some cases, surgeons may open the artery and scrape the plaque out to restore the artery to usable condition. Hospitalization after a bypass operation varies from a few days to more than a week. Recovery from surgery may take several weeks.

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