Critical Limb Ischemia

Critical limb ischemia (CLI) refers to severe compromise of blood flow to alimb (hands or legs) which causes severe limb pain at rest or even loss of limb. It is the most advanced form of peripheral artery disease.

CLI numbers:

  • Prevalent in 2% patient over 70 years of age.
  • Within 1 year of diagnosis, 40-50% patientshave an amputation and 25% die.

How CLI leads to amputation?

Amputation occurs when there is marked ischemia of the limb owing to reduction of blood flow and increase demand in the limb.

Factors that reduce blood supply:

  • Diabetes mellitus
  • Severe Renal or Heart failure
  • Vasospastic diseases
  • Smoking

Factors that increase demand for blood flow:

  • Infection (cellulitis)
  • Skin breakdown
  • Trauma
  • Osteomyelitis

 Diagnosis of CLI:


Duplex Ultrasound Digital – Subtraction Angiography Magnetic Resonance Angiography (MRA) Computed Tomographic Angiography (CTA)
  • Noninvasive
  • Can Visualize & Quantitate severity


  • Gold Standard
  • High Resolution
  • Can guide intervention


  • Noninvasive
  • No radiation
  • No contrast
  • 3 D
  • Noninvasive
  • Higher Resolution than MRA
  • 3 D


  • Operator dependent
  • Limited by
    dense calcification

  • Invasive
  • Radiation
  • Contrast
  • 2 Dimensional


  • Lower Resolution than CTA
  • Claustrophobia
  • Contrast Image artifact if stent present
  • Radiation (25% of dose with DSA)
  • Contrast
  • Limited by calcification 


Management plan for critical limb ischemia:

Critical Limb Ischemia Non-Healing Ulcer Rest Pain

  •  MRA, CTA or invasive argiography shows lesion treatable by endovascular approach
    • Endovascular revascularization ->Wound care and atherosclerosis risk factor modification
    • Lesion treatable by open sugery at acceptable operative risk
      • Surgical revascularization ->Wound care and atherosclerosis risk factor modification
      • Consider primary amputation ->Wound care and atherosclerosis risk factor modification


Subscribe to Newsletter

Don’t Miss Our Heart Updates

Please enable the javascript to submit this form


Thursday 8 am–8 pm
Friday 8 am–8 pm
Saturday 8 am–8 pm
Sunday 8 am–8 pm
Monday 8 am–8 pm
Tuesday 8 am–8 pm
Wednesday Closed

Emergency round the clock

Contact Me

Contact Dr. Raghu and his team at:
OPD appointments: 040 4959 4959 / +91 95424 75650
Cardiac ICU (Emergencies):
040 4456 9955
Cath Lab (Cath lab listing of cases):
040 4456 9959