Recently, the American Heart Association released new guidelines on diagnosing and treating CLI (critical limb ischemia.) But in order to understand the updated guidelines, we must first understand the condition itself.
What is Critical Limb Ischemia?
Critical limb ischemia (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, or PAD). PAD and CLI are both caused by a buildup of fatty plaque deposits in your arteries that leads to atherosclerosis, the hardening and narrowing of those arteries.
CLI is a painful, chronic condition. It makes your feet or toes hurt, even when you are at rest. If left untreated, CLI can leave you with ulcers (sores that won’t heal) on your legs or feet, or even make amputation necessary.
Symptoms of Critical Limb Ischemia
The best known CLI symptom is ischemic rest pain, when your legs and feet hurt a lot when you stop moving. Ulcers on your feet and legs are also common with CLI. Other symptoms include:
- Pain or numbness in your feet
Shiny, dry and smooth skin on your legs or feet
A loss of or lessened pulse in your legs or feet
In severe cases, gangrene (dry, black skin) on your legs or feet
Diagnosing and Treating CLI
In their new scientific statement, the American Heart Association (AHA) highlighted the importance of an diagnosis and treatment plan for 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.
After all, according to the new statement, 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 the statement writing group, led by Dr. Sanjay Misra, of the Mayo Clinic.
“A thorough evaluation of limb perfusion is important in the diagnosis of CLI because it can not only enable timely diagnosis but also reduce unnecessary invasive procedures,” the writing group says.
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 have been most likely to use the ankle-brachial index (ABI) to detect CLI, but with this new statement, the American Heart Association suggests that checking toe pressure will deliver a more accurate diagnosis.
Interestingly, the writing group also touched on experimental technologies for checking blood flow in your lower extremities, including a contrast-enhanced ultrasound like the kind we can provide in our Houston 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, medscape.com