Treatment for Critical Limb Ischemia

The arteries to your legs may become blocked over time due to progressive hardening and occlusion of the vessels (also known as arteriosclerosis) as a result of smoking, high cholesterol, diabetes, obesity or hypertension.  When arteries become narrowed or blocked, the supply of blood and oxygen is reduced and can cause symptoms such as muscle pain, numbness, pins and needles and feeling cold.  If left untreated, the leg can develop foot ulcers or eventually gangrene of the foot and loss of limb. 

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1. Closed Procedure (Angioplasty)

Angioplasty or stenting is a procedure used to treat the narrowing or blockage of an artery. This uses either a balloon to stretch the artery (angioplasty) or metal scaffold to hold the artery open (stent). These procedures improve blood flow which helps to relieve any symptoms you are experiencing.

Click to view American Heart Institute video on Treatment for Critical Limb Ischemia

What to Expect during the Procedure

Local anaesthesia is used during the procedure.  An X-ray dye (also known as contrast) is injected and then a series of X-ray images will be taken to identify areas of narrowing or blockage in the artery.  A fine wire with a catheter will be passed through the narrowing or blockage in the artery and followed by either;

  • inflation of a balloon to enlarge the narrowing (this procedure is called angioplasty)
  • introduction of a stent to be placed in the artery to maintain the opening

2. Open Procedure (Surgery)

This is usually  done under general anaesthesia or regional block.  Procedure requires fasting and is done in an operating theatre (unlike angioplasty which done in an angio suite). Some centres have hybrid facility and both endo and open surgery can be done at the same room.  Open surgery options include;

a) Endarterectomy (the removal or excision of plaque from a relatively normal artery

b) Bypass surgery using vein (patient’s own) or graft (prosthetic) material 

Image Healthwise

c) Hybrid procedure which combines both open and closed (angioplasty / stent) for complex arterial diseases

Possible risks involved

Any medical procedure has a small risk of potential complications.  These include;

  • Allergy to the X-ray dye (MRI, CT scan or conventional angiography) which can lead to hypersensitivity reaction.  The contrast can cause renal injury and so pre-operative assessment requires kidney function test.  Ensure adequate hydration and stopping certain medications like NSAIDS before the procedure
  • Bruising, bleeding or infection at the wound site
  • Artery rupture, tear or swelling (pseudoaneurysm) during the procedure
  • Worsening of the blood flow to the feet or toes depending on the quality of blood vessels in the foots which may be already poor or diseased
  • Sometimes, your doctor may need to proceed to a bypass surgery if angioplasty or stent is not possible or due to intra-operative complications

Post-treatment Care

The success rate of the procedure is usually around 90-95% although it depends on the extent and cause of your artery blockage.  It is important that you modify your lifestyle to live a more healthy lifestyle to reduce the risk of early recurrence of the disease.  This includes;

  • Stop smoking or enroll in a Nicotine Cessation program and counselling
  • Increasing physical activity or doing more gentle exercises such as walking
  • Losing weight to achieve an ideal BMI
  • Eating more healthy diet with less fat and cholesterol
  • Keeping better control of your pre-existing health conditions (such as diabetes or hypertension)
  • Using blood thinning medications such as anti-platelet (such as Aspirin, Clopidrogel or Ticagrelor) or anti-coagulation (such as Rivaroxaban or Apixaban)
  • Visiting your Nursing or Foot Care Practitioner and Vascular Surgeon regularly to examine your leg and foot for calluses, pressure sores / ulcers, pulse  and pressure measurements (ABSI)

See a Vascular Surgeon to discuss your treatment options

Disclaimer. TELEME blog posts contains general information about health conditions and treatments. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. The information is not advice and should not be treated as such. 

If you think you may be suffering from any medical condition, you should seek immediate medical attention from your doctor or other professional healthcare providers. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.

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