Chronic Limb-Threatening Ischemia: When PAD Gets Worse

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Chronic limb-threatening ischemia (CLTI), also called critical limb ischemia, is a serious complication of peripheral artery disease (PAD). People with CLTI have severe blockages in the arteries in their feet, legs or hands. This condition can lead to amputation of the affected limb and is associated with a higher risk of stroke or heart attack.

Tamer Boules, M.D., a vascular surgeon with Henry Ford Health, explains what you should know about critical limb ischemia and how to prevent it.

Causes Of Chronic Limb-Threatening Ischemia

CLTI happens when plaque buildup from PAD gets worse over a period of weeks, months or years. The plaque eventually forms a complete blockage in several arteries. Skin, muscles and nerves in the affected limb can then become damaged or die because they aren't receiving the blood they need. In its most severe form, CLTI can lead to the loss of a limb.

"Usually, CLTI affects the lower limbs, with the feet most severely affected," says Dr. Boules. "This happens because your lower limbs are the furthest downstream from several levels of blockage. But CLTI can affect the arms and hands as well."

Still, not everyone with PAD develops CLTI. Why does this condition affect some people but not others?

"Certain factors greatly increase your chances of developing severe blockages in your peripheral arteries," says Dr. Boules. "These things can take PAD from mild to limb-threatening."

CLTI risk factors include:

• Tobacco use: Smoking directly damages the artery walls, causing plaque buildup and inflammation in your arteries. These two factors make you more likely to develop severe PAD.
• Diabetes: Having Type 2 diabetes causes plaque buildup in the arteries, especially in the legs and feet. It also narrows the arteries, which limits blood flow. If you smoke and have diabetes, your risk of CLTI goes up even more.
• High cholesterol: If you have PAD, your provider may recommend cholesterol-lowering medications such as statins, even if your cholesterol is considered acceptable for those without PAD. "High cholesterol is a major risk factor for CLTI, so we often treat it more aggressively in people with PAD, targeting a much lower LDL, or 'bad' cholesterol," says Dr. Boules. "Statins help to slow the progression of PAD and stabilize existing plaque in the arteries so it's less likely to form a blockage."
• High blood pressure: High blood pressure contributes to PAD. If your blood pressure isn't under control, PAD can get worse and eventually lead to CLTI.
• Genetics: Some people have genetic factors that make them more likely to have severe PAD. "Tell your provider if you have a close relative with severe PAD or CLTI," advises Dr. Boules. "A strong family history may lead to earlier diagnosis and treatment. Doctors can then prescribe medications that may reduce the severity of PAD in the long term."

Knowing The Symptoms Of Critical Limb Ischemia

If you have PAD, keep an eye out for symptoms of CLTI. Red flags include:

• Black areas on feet or legs where skin has died, known as gangrene
• Foot pain while resting or at night
• Ulcers (sores) that won't heal, which are especially common in patients with diabetes and PAD

Critical Limb Ischemia Treatment Can Save Your Limb

If you have symptoms of CLTI, contact your provider right away. "Getting prompt treatment can restore blood flow and prevent further tissue damage," says Dr. Boules.

A vascular surgeon can treat CLTI with endovascular treatments, such as balloon angioplasty and stenting. These minimally invasive procedures involve guiding a tiny balloon-catheter through an artery in your groin to open the blockage. There are no incisions, and you only need local anesthesia. Patients often go home the same day and resume regular activities within a few days.

"Many patients are hesitant to see a vascular surgeon because they think they'll need major surgery, but this is most often not the case," says Dr. Boules. "With today's technology, we can save your limb and avoid a long hospital stay."

However, Dr. Boules emphasizes that seeing your provider right away is key. The longer you wait, the more damage your tissues may have. "The sooner you receive treatment, the better your chances of a good outcome," he says.

Keep Close Tabs On PAD

It can be stressful or even scary to consider your risk of CLTI, but you're not powerless against it. A heart-healthy lifestyle and regular visits with your provider can keep PAD under control. And managing PAD is the best way to keep severe complications like limb loss from happening to you.

"PAD is a common condition, but you can take steps to keep it from getting worse," says Dr. Boules. "Quitting smoking and managing your blood sugar if you have diabetes are essential first steps. A healthy diet and physical activity can also make a big difference. These changes aren't always easy to make-but your limbs are worth the effort."

Reviewed by Dr. Tamer Boules, a vascular surgeon who sees patients at Henry Ford West Bloomfield Hospital.

Categories : FeelWell

Tags : Vascular, Tamer Boules, Heart