Critical limb ischemia (Reduced blood ﬂow or oxygen supply) or CLI is a condition in which there is a severe blockage in the blood vessels
In order to spread awareness about “Critical limb ischemia” (CLI), a condition in which there is a severe blockage in the blood vessels that reduces blood ﬂow to hands, feet and legs. CLI is a severe stage of peripheral arterial disease (PAD) in which the blood supply to the limb is critically low and if not replenished amputation is inevitable.
Professor Dr Digvijay Sharma HOD Vascular Interventions & Surgery, Fortis Hospitals Delhi, said: “In the starting the patients starts feeling pain during walk, the gradually the rest pain begins followed by ulcer and gangrene (redness and swelling or loss of sensation).”
Critical limb ischemia (CLI) and what are its management options:
Critical limb ischemia (Reduced blood ﬂow or oxygen supply) or CLI is a condition in which there is a severe blockage in the blood vessels that markedly reduces blood-ﬂow of the extremities such as hands, feet and legs. It is a severe stage of peripheral arterial disease. In simple term this means that the blood supply to the limb is critically low and if not replenished amputation is inevitable .1, 2
Starts with pain on walking, progresses to rest pain ulcer and gangrene, vascular surgeons use Rutherford’s ischaemia score to stage this condition.
The risk factors for PAD and CLI include older age, smoking, high cholesterol levels, chronic kidney disease, hypertension, and diabetes. In fact, smoking greatly increases the risk of CLI so much so that smoker with controlled pressure and sugars are more vulnerable that, non smokers with moderately controlled pressure and sugars.
Absolutely, having a CLI makes us more vulnerable to death than even most cancers of stage IV, or any heart attack . One look at the above slide clearly explains that a pt of CLI not making it upto 5 years is surpassed only by Lung cancer. This is where our “Save limb save lives” campaign has relevance. If we can mitigate amputations we do save lives.
Treatment for CLI can be quite complex and individualised. However, the number one priority is to preserve the limb.
Replenishing blood supply is the goal and it varies from supervised exercise with reduction of risk factors, medicines to facilitate blood ﬂow through narrowed channels, bypass surgery, angioplasty, converting deep veins into arteries , stem cells etc are all part of Limb Salvage Program. Please be clear that foot has skin muscles joints bones tendons nerves and vessels. This is a complex unit and thus limb salvage services with Vascular, Plastic and are constructive and Orthopedics along with Emdocrinology and foot device specialists give the best outcomes. This is a team eﬀort. The inset shows a very good outcome after angioplasty below the ankle
Cell-based therapies have emerged as a new frontier in this direction, and are now being considered as a potential newer therapeutic alternative for CLI.
Stem cells have a great deal of potential for diﬀerentiation and evolution into various cell types. The surrounding cellular environment gradually stimulates the stem cells, resulting in the creation of specialised cells that are identical to those with which they come into contact and grow.
The eﬀects of this, notably neoangiogenesis, ability to develop into new small blood vessels. As a result, restoring blood circulation and responsible for these reparative activities.
According to the latest clinical evidence, autologous cell treatment has the potential to favourably alter the natural history of intractable CLI with a superior composite clinical result.
It revealed a decrease in amputation risk, an increase in amputation-free survival, enhanced wound healing, and a decrease in rest pain without altering mortality.
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