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Treating PAD and CLI
Vascular Disease Foundation, National Heart, Lung and Blood Institute
Posted: April 1, 2008
Critical Limb Ischemia (CLI) is a severe obstruction of the arteries that seriously decreases blood flow to the extremities (hands, feet and legs) and has progressed to the point of severe pain and even skin ulcers or sores.
CLI is often present in individuals with severe Peripheral Arterial Disease (PAD). The pain caused by CLI can wake up an individual at night. This pain, also called "rest pain," can be relieved temporarily by hanging the leg over the bed or getting up to walk around.
CLI is very severe condition of PAD and needs comprehensive treatment by a vascular surgeon or vascular specialist. This condition will not improve on its own.
Treatment for CLI can be quite complex and individualized, but the overall goal should always be to reduce the pain and improve blood flow to save the leg.
Lifestyle changes
Treatment of PAD often includes making long-lasting lifestyle changes, such as:
- Quitting smoking
- Lowering blood pressure
- Lowering high cholesterol levels
- Lowering blood glucose levels if you have diabetes
Talk with your doctor about participating in a supervised exercise therapy program. Follow a low-saturated fat, low-cholesterol diet, and eat foods with less salt, total fat, and saturated fat. Eat more fruits, vegetables, and low-fat dairy products. If you are overweight or obese, work with your doctor to develop a reasonable weight-loss plan. If you are diabetic or at risk for critical limb ischemia, have your feet examined regularly.
Medicines
Medicines may be prescribed to:
- Lower high cholesterol levels and high blood pressure
- Thin the blood to prevent clots from forming due to low blood flow
- Dissolve blood clots
- Help improve pain in the legs that is the result of walking or climbing stairs (claudication)
Surgeries or Special Procedures
Angioplasty may be performed to restore blood flow through a narrowed or blocked artery. During the procedure, a thin tube (catheter) is inserted into a blocked artery and a small balloon on the tip of the catheter is inflated. When the balloon is inflated, plaque is pushed against the artery walls. This causes the artery to widen, restoring blood flow. A stent, a tiny mesh tube that looks like a small spring, is now used in most angioplasties. Some stents are coated with medicine to help prevent the artery from closing again.
Sources: Vascular Disease Foundation, National Heart, Lung and Blood Institute
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