Chronic limb threatening ischemia

Chronic limb-threatening ischemia (CLTI), previously known as critical limb ischemia (CLI), is a severe manifestation of peripheral artery disease that results in significantly reduced blood flow to the lower extremities, leading to ischemic rest pain, non-healing ulcers, or gangrene. It represents the end stage of peripheral artery disease and is associated with a high risk of limb loss and mortality if left untreated. The condition arises due to progressive atherosclerosis, which leads to arterial narrowing or occlusion, impairing circulation and tissue perfusion.

Chronic limb-threatening ischemia is diagnosed based on clinical symptoms and objective measures of perfusion, including the ankle-brachial index, toe-brachial index, transcutaneous oxygen pressure, or skin perfusion pressure. Imaging techniques such as angiography, fluorescence imaging, and subcutaneous oxygen biosensors, are emerging tools for assessment and treatment planning.

Management of chronic limb-threatening ischemia involves risk factor modification, including smoking cessation, lipid-lowering therapy, and glycemic control, alongside pharmacologic interventions such as antiplatelet therapy and antihypertensives. Exercise therapy plays a role in improving collateral circulation, while endovascular or surgical revascularization is often required to restore adequate blood flow and prevent amputation in advanced cases.

Given its high morbidity and mortality rates, early recognition and a multidisciplinary approach are essential for optimizing patient outcomes.