Critical Limb Ischaemia

Ischemia is a serious condition in which the blood and oxygen supply to specific parts of the body is inadequate. If it invades legs, the condition is called critical limb ischaemia. It can cause tissue damage and loss of limbs in some severe cases. CLI symptoms include claudication, toe nails thickening, etc. Critical limb ischaemia treatment aims to recover limb blood supply as soon as possible and may involve various endovascular procedures (cutting balloon, laser atherectomy) and surgery. More detailed information about this condition, symptoms is causes, as well as diagnostics services and critical limb ischaemia treatment is presented below.

This is a condition where there is severe blockage in the arteries of the lower extremities, which markedly reduces blood-flow. This is is the advanced stage of peripheral arterial disease but less common than claudication.

It is a chronic condition that causes severe pain in the feet or toes, even while resting. Complications of poor circulation can include sores and wounds that won’t heal in the legs and feet. If left untreated, the complications will result in amputation of the affected limb.

What causes Critical Limb Ischaemia?

It is caused by atherosclerosis where arteries harden and become narrow over time due to the buildup of fatty deposits called plaque.

The risk factors for critical limb ischemia include:

  • Age (Men over 60 and women after menopause)
  • Smoking
  • Diabetes
  • Overweight or obesity
  • Sedentary lifestyle
  • High cholesterol
  • High blood pressure
  • Family history of vascular disease


A prominent feature of critical limb ischemia is called ischemic rest pain whereby the patient experiences severe pain in the legs and feet while a person is not moving, or non-healing sores on the feet or legs. Warning signs include:

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


It is a serious condition that requires immediate treatment to re-establish blood-flow to the affected area. The treatment goal is to preserve the limb.

Endovascular treatments

Minimally invasive endovascular therapy is often an option. The treatment option recommended depends on the location and severity of the blockages. Most patients have multiple arterial blockages. This includes blockages of the arteries below the knee. Some of the endovascular procedures include:

    • Angioplasty: A tiny balloon is inserted through an incision in the groin. The balloon is inflated using a saline solution to open up the artery.
    • critical limb ischaemia; CLI symptoms; Critical limb ischaemia treatment; cutting balloon; laser atherectomy

Cutting balloon:

      • A balloon with micro-blades is used to dilate the affected area. The surface is cut open to reduce the force necessary to dilate the vessel.

Cold balloon:

    • The balloon is inflated using nitrous oxide instead of saline. The gas freezes the plaque. This procedure is easier on the artery, the growth of the plaque is halted and little scar tissue is generated.
    • Stents: Metal mesh tubes are left in place after an artery has been opened using a balloon angioplasty.


      • The stents are expanded using a balloon. These stents are stronger but less flexible.


    • Compressed stents are delivered to the affected site and expand upon release. These stents are more flexible.
  • Laser atherectomy: Laser is used to vaporize small bits of plaque
  • Directional atherectomy: A catheter embedded with rotating cutting blade is used to physically remove plaque from the artery, opening the flow channel.
  • critical limb ischaemia treatment with rotational atherectomy

Recovery time from these procedures normally takes 1 or 2 days and most are done on an outpatient basis.

Surgical treatments

Additional surgical procedures or other follow-up care are required in treating wounds or ulcers. Surgical treatment is often recommended if the arterial blockages are not favorable for endovascular therapy. This normally involves bypass around the diseased segment with either a vein from the patient or a synthetic graft. Hospitalization after the procedure range from a few days to more than a week. Recovery time may take several weeks.


  • Auscultation: A whooshing sound (bruit) is heard in the arteries of the legs using a stethoscope.
  • Ankle-brachial index (ABI): The systolic blood pressure in the arm is divided by the systolic pressure at the ankle
  • Doppler Ultrasound: Measure the direction and velocity of blood-flow through the vessels
  • CT angiography: An advanced X-ray procedure that uses a computer to generate 3D images
  • Magnetic resonance angiography (MR angiography): Radiofrequency waves in a strong magnetic field is used in this procedure. The energy released is measured by a computer and is used to construct 2D and 3D images of the blood vessels
  • Angiogram: X-ray study of the blood vessels is taken using contrast dyes