Complications from Peripheral Artery Disease Lead to Critical Limb Ischemia

Patients with peripheral artery disease have a serious condition that puts them at risk for a variety of health complications. These complications range from numbness or loss of feeling in the extremities to a heightened risk of blood clots and a dangerous condition known as Critical limb ischemia.Critical limb ischemia, or CLI, happens in patients with peripheral artery disease when an artery becomes obstructed as a result of severe atherosclerosis, or arterial plaque buildup.

Arterial plaque buildup often occurs in patients with high cholesterol, high blood pressure and diabetes. It also occurs in patients who smoke, abuse alcohol and lead sedentary lifestyles. Arterial plaque reduces blood flow and impacts the ability of the blood to circulate through the body to the hands, legs and feet. CLI is so dangerous for PAD patients that it could result in amputation of the feet or legs.

In patients with CLI, the arterial obstruction is severe and causes intense, painful leg cramping. Patients with CLI typically experience this cramping at night, during sleep, when blood pools in the leg. CLI patients report that this pain is often severe enough to wake them at night.

Many patients with CLI develop sores and skin ulcers as a result of their condition. These sores are slow to heal, as oxygen and nutrient rich blood flow to the area is reduced. Slow healing wounds are prone to infection, causing additional health woes for the patient.

Signs of critical limb ischemia include pain and numbness in the leg when stationary, a cool or cold feeling in the leg or foot in relation to the rest of the body and slow healing wounds on the leg or foot. Other symptoms include shiny dry skin on the legs and feet, hair loss on the lower legs and thickening of the toenails.

Patients with CLI also have an absent or weakened pulse in the lower legs or feet. This is a symptom that is found upon examination by a physician. Dr. Michael Budler, M.D., is a physician treating patients with peripheral artery disease and CLI at his Grand Island, Nebraska, clinic.

“Lack of pulse or diminished pulse in the legs and feet is a telltale sign of peripheral artery disease and critical limb ischemia,” Budler said.

While other symptoms of the condition, like sores and loss of hair can be seen by the patient, blood flow reduction cannot.

“Patients with PAD should have an ankle-brachial index, or ABI, screening to check the blood pressure level in the patient’s legs against the blood pressure level in the patient’s arms in order to determine if their legs are getting the necessary blood flood,” Budler said.

Once a patient is diagnosed with PAD, Budler treats patients using angioplasty or vascular stenting. Angioplasty involves the insertion of a small catheter into an artery where the blockage is, and once in position, a small balloon is inflated in the artery to push the plaque back against the arterial wall. This procedure increases blood flow.

Vascular stenting is similar to angioplasty, but wire mesh tubing is inserted via the catheter to hold the plaque back against the wall. This wire mesh also helps to hold the artery open. Both of these actions help to increase the patient’s blood flow.

Critical limb ischemia and peripheral artery disease need medical interventions. If not treated, patients face the risk of infection, sepsis, the loss of limbs, stroke, heart attack and death.

“Loss of limb is a very real reality for CLI patients,”  Budler said. “Early intervention is critical to safe the limb, and really, the life of the patient.” 

According to the Journal of the American Heart Association, there are 150,000 patients diagnosed with CLI each year. The prognosis for these patients is bleak when the condition is untreated.