Critical limb ischaemia (CLI) occurs when the arterial insufficiency is so bad that there is significant risk of limb loss without intervention. Such patients experience rest pain which is particularly bad at night (nocturnal rest pain) and is relieved by dangling the led out of bed. Such patients may also have skin breakdown or gangrene affecting their foot/toes.
Patients with CLI usually have multi-level disease in the arterial tree whereas patients with claudication may have single segment disease. Investigations for CLI are the same as for patients with intermittent claudication, except that these patients need more active approach to prevent limb loss.
Treatment strategies for CLI include:
- Angioplasty – may be performed alone or in conjunction with endarterectomy procedure or bypass
- Surgical bypass – examples include femoropoliteal, femorodistal, aortobifemoral, axillobifemoral
- Amputation – may be required if the angioplasty/bypass has failed or is not possible due to extensive distal disease (as may be the case particularly in diabetics). It is effective in relieving pain in such patients.
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