Chronic limb threatening ischemia

Chronic limb threatening ischemia
Other namesCritical limb ischemia, limb threat

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.[1] It represents the end stage of peripheral artery disease and is associated with a high risk of limb loss and mortality if left untreated.[1][2] The condition arises due to progressive atherosclerosis, which leads to arterial narrowing or occlusion, impairing circulation and tissue perfusion.[3]

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.[1][2][3] Imaging techniques such as angiography, fluorescence imaging, and subcutaneous oxygen biosensors, are emerging tools for assessment and treatment planning.[4][5]

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.[1][2][6]

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

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