Limb Ischemia

Limb ischemia is an obstruction of the arteries that seriously decreases blood flow to the extremities (hands, feet and legs) and has progressed to the point of severe pain and even skin ulcers or sores. Limb ischemia is often present in people suffering from severe cases of peripheral arterial disease (PAD).

Causes and Risk Factors for Limb Ischemia

Limb ischemia may be due to an acute condition such as an embolus or thrombosis, but most cases are the progressive result of a chronic condition, most commonly atherosclerosis, also known as hardening of the arteries.

Risk factors for limb ischemia are:

  • Age
  • Smoking
  • Diabetes
  • Obesity
  • Sedentary lifestyle
  • High cholesterol
  • High blood pressure
  • Family history of atherosclerosis or claudication

Symptoms of Limb Ischemia

The primary symptom of limb ischemia is called ischemic rest pain, which is severe pain in the legs and feet while a person is not moving. Ischemic rest pain is typically described as a burning pain in the arch or distal foot that occurs while the patient is recumbent but is relieved when the patient returns to a position in which the feet are dependent.

Other symptoms may include:

  • Pain or numbness in the feet
  • Shiny, smooth, dry skin of the legs or feet
  • Thickening of the toenails
  • Absent or diminished pulse in the legs or feet
  • Open sores, skin infections or ulcers that will not heal
  • Gangrene (dry, black skin) of the legs or feet

Diagnosing Limb Ischemia

Your doctor will need to identify and locate the cause of blockages associated with limb ischemia. This may be done using one or more of the following methods:

  • Using a stethoscope to find a bruit or "whooshing" sound
  • Using the ankle-brachial index (ABI)
  • Using a Doppler ultrasound to measure the direction and velocity of blood-flow through the vessels
  • Using CT angiography, an advanced X-ray procedure that uses a computer to generate three-dimensional images
  • Using magnetic resonance angiography (MRA), during which the patient is exposed to radiofrequency waves in a strong magnetic field. A computer measures the energy released and uses it to construct two- and three-dimensional images of the blood vessels
  • Using a peripheral angiogram, which is an X-ray study of the blood vessels using contrast dyes

Treatment Options for Limb Ischemia at St. Joseph's Heart & Vascular Institute

Limb ischemia is a serious condition that requires immediate treatment to re-establish blood-flow to the affected area. The recommended treatment will depend on the location and severity of the blockages. The primary goal is to preserve the limb.

In some cases, minimally invasive endovascular therapy is an option. These procedures include:

  • Angioplasty
  • Stents
  • Laser arthrectomy: Small bits of plaque are vaporized by a laser probe
  • Directional arthrectomy: A catheter with a rotating cutting blade removes plaque from the artery

If the arterial blockages cannot be treated with endovascular therapy, your doctor may recommend surgery. Surgical intervention includes:

  • Revascularization (using bypass grafts, or arteriography)
  • Amputation

Patients with limb ischemia require life-long follow-up.