What Is Chronic Limb-Threatening Ischemia (CLTI)?

Chronic limb-threatening ischemia (formerly critical limb ischemia) occurs when severe artery blockages limit blood flow to your arms and legs. It is a complication of advanced peripheral artery disease that causes tissue loss and severe pain when your legs are not moving. Limb ischemia is an ongoing condition that only gets better with treatment. 

If it progresses to advanced stages, amputation (surgically removing a limb) may be necessary to save your life. But it’s treatable in earlier stages, which is why expert care is essential.

Our team regularly diagnoses and treats lower limb ischemia, so you receive exceptional care at every turn. We catch signs that can be easy to miss, leading to an earlier diagnosis. You also have access to advanced treatments that restore blood flow. This depth of experience helps more patients avoid amputation and live an excellent quality of life. Meet our team.

You can count on Virginia Mason Franciscan Health for timely chronic limb-threatening ischemia treatment. We see patients with urgent concerns promptly and provide lifelong care.

CTLI symptoms may include: 

• Cold extremities (new symptom)
• Gangrene, tissue death due to infection or poor blood supply 
• Numbness (new symptom)
• Slow-healing wounds (skin ulcers)
• Thick toenails
• Weak or no pulse

CLTI occurs when you have long-lasting peripheral artery disease (PAD). With PAD, buildups of a waxy substance (plaque) limit blood and oxygen flow to your extremities. Over time, PAD can cause irreversible tissue damage that may require amputation.

Certain factors raise your risk for CLTI. They include: 

• Lifestyle: Smoking and lack of physical activity increase the risk of lower-limb ischemia.
• Other medical conditions: You face a higher risk if you have diabetes, high blood pressure or high cholesterol.

CLTI evaluations start by assessing your blood flow. We may first check the pulse in your arms and legs (ankle-brachial index) to determine what other tests you may need. Services include duplex ultrasound in our accredited vascular testing lab and advanced studies through our imaging and radiology department.

We aim to help you avoid amputation. Limb preservation surgery can restore blood flow to the affected limb when medical therapies aren’t successful. We often use minimally invasive methods that involve small incisions and tiny instruments to remove plaque buildups. Additional options include traditional open surgery, such as bypass procedures to reroute blood flow around diseased vessels.

Learn mkore about testing and treatments in the Puget Sound.