If you have PAD, you should understand the American Heart Association's guidelines for diagnosing and treating CLI (critical limb ischemia.) But in order to understand the guidelines, we must first understand the condition itself.
CLI is a severe blockage in the arteries of your lower extremities. It 
dramatically reduces blood flow to your lower limbs, making it a serious form of PAD (peripheral arterial disease). PAD and CLI are both caused by a buildup of plaque in your arteries. And that buildup leads to atherosclerosis, the hardening and narrowing of your arteries.
CLI is a painful, chronic condition. It makes your feet or toes hurt, even when you're resting. Advanced CLI may cause you to develop ulcers (sores that won't heal) on your legs or feet. Some CLI patients even need amputations.
The best known CLI symptom is ischemic rest pain. This refers to the discomfort you feel in your legs and feet hurt when you stop moving. Ulcers on your feet and legs are also common. Other symptoms include pain or numbness in your feet. You may also notice shiny, dry and smooth skin on your legs or feet, as well as thickened toenails. A vein specialist may notice you've lost or lowered the pulse in your legs or feet. And, in severe cases, you may see gangrene (dry, black skin) on your legs or feet.
The American Heart Association (AHA) emphasized the importance of diagnosing and treating CLI.
"Timely diagnosis and treatment is likely to preserve limb viability and improve quality of life," Mark A. Creager, MD, past AHA president and director, explained to theheart.org. 
Why? CLI affects an estimated 12 million adults in the United States, but diagnosing and managing the condition can be "challenging." Moreover, strategies for perfusion assessment (testing your cardiovascular system's ability to supply your tissue with enough blood flow) "remain limited," according to Dr. Sanjay Misra of the Mayo Clinic. And evaluating limb perfusion is crucial because it speeds up the CLI diagnosis and prevents many invasive procedures.
Currently, the guidelines for diagnosing CLI tell physicians to look for ischemic rest pain, an ulcer, or the presence of gangrene for at least 2 weeks. Those symptoms, in combination with reduced blood flow (hypoperfusion) as measured by one of several tests (ankle-brachial index (ABI), ankle pressure, toe-brachial index (TBI), toe systolic pressure, transcutaneous oximetry (TcPo2), or skin perfusion pressure (SPP)) would indicate that a person has developed CLI.
Until now, vein specialists were been most likely to use the ankle-brachial index (ABI) to detect CLI. But under the new guidelines, the American Heart Association suggests that checking toe pressure will deliver a more accurate diagnosis.
Interestingly, the AHA also promotes experimental technologies for checking blood flow in your lower extremities, including a contrast-enhanced ultrasound like the kind we can provide in our Houston and Dallas area vein clinics.
Regarding this kind of scan, the statement says: "New technologies offer potential opportunities to improve the precision and quality of CLI management," helping detect and treat CLI at an earlier stage and reducing the number of amputations associated with this condition.
Sources: American Heart Association, health.ucdavis.edu
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