Critical limb threatening Ischemia
CLTI is a devastating and crippling form of limb ischemia. There is more rest pain,
ulcers don’t heal, and no blood flows to the extremities. At Washington Vascular
Specialists, we provide comprehensive treatment and care solutions for CLIT and
other challenging vascular conditions.
What is CLTI
To understand Critical limb-threatening, we must look back at limb ischemia. Limb ischemia is a peripheral arterial disease (PAD) caused by reduced blood flow in the lower limbs due to the hardening of arteries (atherosclerosis).
Symptoms of limb ischemia include pain in the legs when at rest, numbness, and wounds that take long to heal. Sometimes, the toenails thicken or blacken, accompanied by a noticeable drop of temperature in the legs or feet.
Critical limb-threatening Ischemia (CLTI) is an advanced form of limb ischemia. In 5- 10 years of living with the PAD, up to 10% of patients progress to CLTI.
CLTI Symptoms
CLTI represents a stage of extensive clinical deterioration with signs such as extreme pain and severe numbness in the feet. Other signs include:
· Frequent infection of the extremities
· Gangrene and thickened toenails
· Absent pulse in the legs
· Dry shiny skin of the legs
Causes of CLTI
Thickened arterial walls cause critical limb-threatening due to a build-up of plaque (fatty deposits). The plaque build-up is medically referred to as atherosclerosis, and it constricts and blocks blood flow, curtailing blood circulation to the limbs.
CLTI Risk Factors
The ever-growing cases of CLTI reflect the worldwide struggle to curb tobacco use and overcome obesity and diabetes. A global aging population and increased cases of high blood pressure are the other risk factors for CLTI.
The rapid progress of the CLI to CLIT is a consequence of isolated and uncoordinated care approaches. Prevention of CLIT requires timely and efficacious management of limb ischemia in its initial stages.
CLTI Diagnosis
Physical exam: The first medical diagnosis of CLTI includes a physical exam focused on the feet and legs and guided by the patient’s symptoms and medical history.
Measurement of blood flow: The blood flow rate in the affected limbs is measured using a Doppler flow. A systolic pressure below 30 mm Hg in the toes indicates a high likelihood of CLTI.
Pulse volume: In a vascular laboratory, experts measure pulse waveform at different areas of the leg arteries. Abnormal changes in waveforms identify areas of arterial
blockage.
Treatments for CLTI
Patients with CLTI require a comprehensive treatment approach that entails:
Conservative treatment: This involves modulating risk factors through blood pressure control, smoking cessation, and blood cholesterol control.
Medications: Pharmacological therapies may be instituted to control the condition by reducing cholesterol and blood pressure, preventing clotting, and minimizing the risk of infections.
Endovascular treatments: A small balloon may be inserted into the affected arteries to open them and improve blood flow. This therapy is called angioplasty. Alternatively,
a catheter with a spinning blade is inserted into the arteries to eliminate the plaque in directional atherectomy.
Arterial surgery: If patients are not suitable for or responsive to endovascular therapy, surgery may be a feasible option. In arterial surgery, the PAD is removed and the affected artery replaced with a synthetic graft or a vein from the patient. Amputation of the affected limb or toe is the last resort.
At Washington Vascular Specialists, we implement CLTI treatment approaches that go beyond revascularization. We deliver a multimodal care approach that combines conservative treatment with proven medical and surgical interventions.
