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Critical Limb Ischemia: Advanced Treatment at University of Colorado Hospital

Because CLI patients
are at significant risk
for limb loss, it is
imperative that they
receive care at a facility 
equipped to offer the
most advanced and
effective treatments.

When ischemia (an insufficient blood supply to an organ or area, due to blockage) progresses in the body's lower extremities, it leads to critical limb ischemia, or CLI. This is a serious condition that is often accompanied by severe pain in the calves or thighs.

Critical limb ischemia must be treated quickly to re-establish the blood supply to the affected area ("revascularization"). If left untreated, CLI can lead to tissue death and limb loss.

CLI Patients at Significant Risk of Limb Loss

Critical limb ischemia is the "end-stage" manifestation of peripheral arterial disease, or PAD. As such, it is most often seen in the elderly, among smokers, and in diabetics.

Because CLI patients are at significant risk for limb loss, it is imperative that they receive care at a facility equipped to offer the most advanced and effective treatments.

Symptoms of CLI

The most common symptom of critical limb ischemia include:

  • Pain in the legs and feet when the person is at rest and not moving (also called "ischemic rest pain")
  • Sores or infections on the legs and feet that won't heal
  • Faint or absent pulse in the leg or foot below the blockage

Why Choose UCH for Your CLI Care?

University of Colorado Hospital's reputation for clinical excellence is determined by its outstanding patient outcomes. CLI is a serious condition that warrants serious treatment by expertly-trained surgeons and staff. 

At UCH, your medical team:

  • Uses the latest, advanced technology often not available at community hospitals
  • Has experience in revascularization of large vessels, and those below the knee
  • Achieves an 80% revascularization rate

Tests

Vascular specialists at University of Colorado Hospital use a number of tests to determine the exact causes and severity of CLI, including these imaging assessments:

  • Magnetic Resonance Angiography (MRA) – A computer measures radiofrequency waves in a magnetic field to construct detailed images of blood vessels.
  • Computed Tomography Angiography (CTA) – Contrast dye injected in the blood vessel makes visible any blockages in an advanced x-ray image.
  • Doppler Ultrasound  – Uses sound waves to painlessly measure blood flow through the vessel.

 

To refine diagnostic accuracy, specialists also use hemodynamic (blood-related) assessments, such as ABI (ankle brachial index, a comparison of systolic blood pressure readings at the arms and ankles), toe pressure readings, and measurements of blood oxygen.

Treatments

The primary goals of CLI treatment are to relieve pain and re-establish blood flow to the affected area. The overriding concern, of course, is to save the limb.

 

Crucial to the success of any treatment for PAD or CLI is that a patient who smokes must stop.

 

Your doctor may prescribe medications to stop the progression of CLI, and to lessen the effects of other factors that contribute to it, like high blood pressure or high cholesterol.

 

Endovascular procedures

Stent

This close-up view of a stent shows its lattice-like support structure.

 

Depending on the location and stage of the arterial blockages, your doctor may perform one or more of the following procedures. They are "minimally invasive" and involve the insertion of a catheter through a small incision.

  • Angioplasty – A small balloon is inserted into the artery and then inflated, opening it.
  • Stents – A stent is a tiny meshlike device that can be expanded within the artery to open it and stabilize it.
  • Atherectomy – A catheter, either laser- or blade-tipped, is used to "shave away" plaque in the artery. Vascular surgeons at UCH use the latest catheters such as EV3's SilverhawkTM, Pathway's JetStream G2TM, and CSI's Diamondback 360TM to stay ahead of the curve.

 

Many endovascular procedures are performed on an outpatient basis. Patient recovery time is shorter than that of more invasive procedures – typically one or two days.

 

Surgical procedures

Arterial blockages that do not lend themselves to endoscopic procedures may warrant surgical repair, most often a bypass of the affected area.

 

In this procedure, your vascular surgeon grafts either an artificial vessel, or one of your veins, to become a new artery to carry much-needed blood.

Featured Doctors

 

 

Ivan Casserly, MD, received his doctorate in 2002 from the National University of Ireland – Galway. He is board-certified in cardiovascular medicine and interventional cardiology. Dr. Casserly is an assistant professor of medicine, Division of Cardiology, at the University of Colorado Denver School of Medicine.

 

Rajan Gupta, MD, is an assistant professor in the Division of Interventional Radiology at the University of Colorado Denver School of Medicine. Dr. Gupta received his doctorate from Oregon Health and Sciences University and completed both his residency and fellowship at the University of Colorado Health Sciences Center. He is board-certified in diagnostic radiology.

 
 

 

John Messenger, MD, is an associate professor in the Division of Cardiology and director of the cardiac catheterization laboratory. He received his doctorate at the University of Southern California, completed his residency at University of California, San Francisco, and his fellow ship at University of Colorado Health Sciences Center. Dr. Messenger is board-certified in internal medicine, cardiovascular medicine, and interventional cardiology.
 

 

Mark Nehler, MD, is board-certifed in general surgery and vascular surgery. His clinical interests include chronic venous insufficiency, carotid artery disease, and limb salvage surgery. Dr. Nehler received his doctorate from Oregon Health Sciences University, where he also completed his residency and fellowship. Dr. Nehler is an associate professor in the Division of Vascular Surgery at University of Colorado Health Sciences Center.

 

Minimally invasive treatments

These illustrations show how the SilverhawkTM catheter, which has been inserted into the vessel through a small incision, can eliminate an arterial blockage that is restricting blood flow. UCH physicians perform many minimally invasive procedures on an outpatient basis, which often means shorter patient recovery times.

 

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