Critical limb ischaemia Toto rawaka-kore ki ngā pepeke tinana

Critical limb ischaemia is caused by peripheral vascular disease. This is where an artery in your arm or leg has narrowed due to a build up of plaques, or fatty deposits (atherosclerosis). This means less blood and oxygen is delivered to your arms, legs or feet. 

When body tissues do not get enough blood supply, the tissue can die. This shows as dry, black skin and is called gangrene.

Peripheral vascular disease

Atherosclerosis

The symptoms of critical limb ischaemia include:

• severe pain in your limb, even when at rest
• ulcers or sores that are slow to heal.

Foot ulcers

To diagnose critical limb ischaemia, your healthcare provider will:

• examine you
• ask you questions about your health and about your family's health.

They may arrange tests such as:

• an ankle-brachial pressure index
• a doppler ultrasound
• an angiogram.

Tests for blood vessel problems

Critical limb ischaemia is a serious condition and does not get better by itself. you will need to see a vascular surgeon (a surgical doctor who specialises in blood vessels).

Treatment options include:

• stopping smoking
• walking exercise
• medication
• surgery.

Stopping smoking

If you smoke, the most effective treatment for peripheral vascular disease is to completely stop. Your symptoms will improve within a few weeks of stopping.

Walking exercise

Walking exercise can be as good for critical limb ischaemia as surgery. As well as helping you keep active, walking helps small new blood vessels grow, which improves the blood flow in your legs.

While any walking is good for your health, you need to do a high intensity programme to improve your symptoms. This involves walking for 30 minutes every day at a speed that causes pain in your legs. When you feel pain, stop and rest until it goes away and then start again.

If you feel embarrassed stopping and starting while walking on the street, you could try walking in a shopping mall.

Medication

You are likely to be prescribed:

• a statin cholesterol medicine (even if you do not have high cholesterol)
• an anti-clotting medicine like low-dose aspirin or clopidogrel to help prevent blood clots from forming.

If you have high blood pressure or diabetes, it is very important you have these well controlled. Your healthcare provider will make sure you have the medication you need to control these conditions.

Surgery

Critical limb ischaemia may be treated with surgery. The main aim of surgery is to save your limb. The surgery might be:

• angioplasty — where the surgeon inflates a tiny balloon in your artery causing it to widen, and possibly fits a stent (a small plastic or metal tube) to keep your artery open
• arterial bypass — where the surgeon redirects the blood flow around the blockage.

If it is not possible to unblock the artery and increase the blood supply, the affected body part (finger, toe, foot or leg) will need to be surgically removed (amputated).