How Is Limb Ischemia Treated?

Reviewed on 11/18/2021

Treatment for limb ischemia involves re-establishing blood flow to the affected area through such procedures as angioplasty, stents, laser atherectomy, directional atherectomy, and surgical treatments.
Treatment for limb ischemia involves re-establishing blood flow to the affected area through such procedures as angioplasty, stents, laser atherectomy, directional atherectomy, and surgical treatments.

Limb ischemia is a severe blockage in the arteries of the lower extremities, which significantly reduces blood flow. It is a serious form of peripheral arterial disease (PAD), a condition that affects blood vessels in the extremities. 

Treatment for limb ischemia involves re-establishing blood flow to the affected area to preserve the limb.

Treatments for critical limb ischemia include the following.

1. Endovascular treatments

Most of these treatments are done on an outpatient basis and recovery takes one or two days:

  • Angioplasty: A tiny balloon is inserted through a puncture in the groin and is inflated using a saline solution, to open the artery
    • Cutting balloon: The balloon is imbedded with micro-blades that cut the surface of the plaque, reducing the force necessary to dilate the vessel
    • Cold balloon (CryoPlasty): The balloon is inflated using nitrous oxide which freezes the plaque; this is easier on the artery
  • Stents: Metal mesh tubes are used to provide scaffolding after an artery has been opened using a balloon angioplasty
    • Balloon-expanded (stronger but less flexible): A balloon is used to expand the stent
    • Self-expanding (more flexible): Compressed stents expand upon release
  • Laser atherectomy: The tip of a laser probe is used to vaporize small bits of plaque 
  • Directional atherectomy: A catheter with a rotating cutting blade physically removes plaque from the artery, opening the flow channel

2. Surgical treatments

  • Wounds or ulcers may require surgical procedures or other follow-up care
  • Surgical treatment may be recommended if endovascular therapy is not beneficial for the arterial blockages 
  • Often involves bypass around the diseased segment with either a vein from the patient or a synthetic graft
  • A bypass operation may require hospitalization from a few days to more than a week
  • Recovery from surgery may take several weeks

What Are Symptoms of Limb Ischemia?

Symptoms of limb ischemia include:

  • Severe pain in the legs and feet while at rest (called ischemic rest pain)
  • Non-healing open sores, ulcers, or skin infections on the feet and legs 
  • Numbness in the feet
  • Shiny, smooth, dry skin on the legs or feet
  • Toenail thickening 
  • Diminished or absent pulse in the legs or feet
  • Dry gangrene (dry, black skin) of the legs or feet

What Causes Limb Ischemia?

Limb ischemia is an advanced stage of peripheral arterial disease (PAD), which is caused by atherosclerosis, the hardening and narrowing of the arteries over time due to the buildup of fatty deposits called plaque.

Risk factors that contribute to limb ischemia are the same as those for atherosclerosis, such as:

How Is Limb Ischemia Diagnosed?

Limb ischemia is diagnosed with a patient history and physical examination. The blockages associated with limb ischemia are located using one or more of the following methods:

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Reviewed on 11/18/2021
References
Image Source: iStock Images

https://health.ucdavis.edu/vascular/diseases/cli.html