Complex Limb Revascularization

Treatment & Prevention

Critical limb ischemia is a serious condition that requires immediate treatment to re-establish blood flow to the affected area or areas. (Most patients with CLI have multiple arterial blockages.) Treatment for CLI can be quite complex and individualized, but the overall goal should always be to reduce the pain and improve blood flow to save the leg. The number one priority is to preserve the limb.

Endovascular Treatments:

These treatments are the least invasive and involve inserting a catheter into the artery in the groin to allow access to the diseased portion of the artery. Angioplasty may be done to open blockages by using small balloons introduced with a catheter into an artery. The balloon is inflated and, as it inflates, it stretches and opens the artery for improved blood flow. A metallic device called a "stent" can then be inserted to maintain the expanded the artery, thereby improving blood flow to the limb. Other treatments include laser atherectomy, where small bits of plaque are vaporized by the tip of a laser probe, and directional atherectomy, in which a catheter with a rotating cutting blade is used to physically remove plaque from the artery.

Arterial Surgery:

If the arterial blockages are not favorable for endovascular therapy, surgery is often recommended. This involves removing or bypassing the arterial disease with either a vein from the patient or a synthetic graft. In a few cases, the surgeon may cut open the artery and scrape out the plaque keeping the artery usable. The last recourse would be amputation of a toe, part of the foot, or leg. Amputation occurs in about 25 percent of all CLI patients.

Since treatment depends on the severity of the disease and many individual parameters, it is essential that someone with ulcers, or pain in the legs or feet when walking or at rest, see a vascular specialist as soon as p