Diabetes is a particularly important risk factor because it is frequently associated with severe peripheral arterial disease. Atherosclerosis develops at a younger age in patients with diabetes and progresses rapidly. Moreover, atherosclerosis affects more distal vessels in patients with diabetes; the profunda femoris, popliteal and tibial arteries are frequently affected, while the aorta and iliac arteries are minimally narrowed. These distal lesions are less amenable to revascularization. Atherosclerosis in distal arteries in combination with diabetic neuropathy contributes to the higher rates of limb loss in diabetic patients compared with nondiabetic patients.
So the key risk factors of CLI as follows;
Overweight or obesity
High blood pressure
Family history of atherosclerosis or claudication
The most prominent features of critical limb ischemia (CLI) are called ischemic rest pain — severe pain in the legs and feet while a person is not moving, or non-healing sores on the feet or legs.
Pain or numbness in the feet
Shiny, smooth, dry skin of the legs or feet
Thickening of the toenails
Absent or diminished pulse in the legs or feet
Open sores, skin infections or ulcers that will not heal
Dry gangrene (dry, black skin) of the legs or feet
Ankle-brachial index (ABI): The systolic blood pressure in the arm is divided by the systolic pressure at the ankle. Ankle systolic pressure of 50 mm Hg or less or a toe systolic pressure of 30 mm Hg or less suggests the presence of critical limb ischemia. Patients with claudication typically have an ankle-brachial index of 0.5 to 0.8, while patients with critical limb ischemia usually have an ankle-brachial index of 0.4 or less.
Doppler Ultrasound: This form of ultrasound can measure the direction and velocity of blood-flow through the vessels.
CT angiography: An advanced X-ray procedure that uses a computer to generate three-dimensional images.
Magnetic resonance angiography (MR angiography): The patient is exposed to radiofrequency waves in a strong magnetic field. The energy that is released is measured by a computer and used to construct two- and three-dimensional images of the blood vessels.
Angiogram: An X-ray study of the blood vessels is taken using contrast dyes.
Angioplasty: A tiny balloon is inserted through a puncture in the groin. The balloon is inflated one or more times, using a saline solution, to open the artery.
Cutting balloon: A balloon imbedded with micro-blades is used to dilate the diseased area. The blades cut the surface of the plaque, reducing the force necessary to dilate the vessel.
Cold balloon (CryoPlasty): Instead of using saline, the balloon is inflated using nitrous oxide. The gas freezes the plaque. The procedure is easier on the artery; the growth of the plaque is halted; and little scar tissue is generated.
Stents: Metal mesh tubes that provide scaffolding are left in place after an artery has been opened using a balloon angioplasty.
Balloon-expanded: A balloon is use to expand the stent. These stents are stronger but less flexible.
Self-expanding: Compressed stents are delivered to the diseased site. They expand upon release. These stents are more flexible.
Laser atherectomy: Small bits of plaque are vaporized by the tip of a laser probe.
Directional atherectomy: A catheter with a rotating cutting blade is use to physically remove plaque from the artery, opening the flow channel.
Recovery from these procedures usually takes one or two days, and most of these procedures are done on an outpatient basis. Treatment includes management of the risk factors of atherosclerosis.
Diagnostic and assessment
Hyperbaric Oxygen Therapy
SCT Regenerative Medical Intervention (Experimental) & Clinical case studies