Critical leg Ischemia is lack of blood flow that endangers all or part of the leg and is usually defined as persistently recurring rest pain for more than two weeks, or ulceration or gangrene of the foot.
Many patients with critical limb Ischemia are elderly and frail, and this is reflected in the prognosis of the condition. Even with treatment, 25% of these patients die within a year and only half survive more than 5 years, mainly due to deaths from myocardial infarction and stroke.
Treatment aims are ulcer healing & limb salvage relatively short term and focus on quality of life as well as long term durability of any procedure.
The pain of severe limb Ischemia is felt in the toes and forefoot and is typically worse at night. Patients wake up in the early hours with severe pain, relieved by hanging the leg out of the bed allowing blood to flow down to the foot.
Some patients take to sleeping in a chair. Many patients get up and walk around in the night which stimulates flow and reduces pain. During the day the patient may suffer short distance intermittent claudication.
This pattern of symptoms: calf claudication by day and rest pain in the toes at night is strongly suggestive of critical limb Ischemia.
Without treatment, critical limb Ischemia will progress, causing worsening pain and debility. Ulcers develop on the lower leg and foot, and ultimately gangrene sets in.
If the problem is left too late it can become impossible to salvage the leg and amputation may become the only way to save the patient's life