Critical Limb-Threatening Ischemia

While rare, uncontrolled peripheral artery disease can lead to critical limb-threatening ischemia. Critical limb-threatening ischemia, formerly known as critical limb ischemia, is a serious condition caused by a lack of blood flow and oxygen to the limbs. The lack of blood flow is caused by plaque buildup in the arteries, which causes blood vessels to become too narrow for oxygenated blood to pass through properly. The result can be tissue damage and potential loss of a limb.


  • Burning, cramping, or pain in muscles that goes away with rest
  • Coldness of the limb
  • Gangrene
  • Loss of tissue in the limb
  • Nonhealing sores or ulcers
  • Pain in the limb that does not improve with rest, if the progression is severe
  • Swelling and stiffness in the affected limb


  • Preventing critical limb-threatening ischemia can start with preventing peripheral artery disease.
  • Quitting smoking can help prevent critical limb-threatening ischemia.
  • Patients who have diabetes can manage their blood sugar levels.
  • Patients with high blood pressure or high cholesterol can work with a cardiologist to get their blood pressure or cholesterol to healthy levels.
  • A healthy diet and regular exercise can help keep the cardiovascular system healthy, which will reduce the risk of critical limb-threatening ischemia.

Risk Factors

  • Advanced age
  • Atherosclerosis
  • Diabetes
  • Family history of heart disease
  • High cholesterol
  • Hypertension
  • Inactive lifestyle
  • Obesity
  • Peripheral artery disease
  • Smoking


  • Medical history and symptom review. The provider will review your symptoms and your lifestyle. The provider may ask about your personal and family history of peripheral artery disease and cardiovascular disease.
  • Ankle brachial index (ABI) test. Your provider will use this test to measure the blood pressure in your legs.
  • Imaging tests. Your provider may recommend a duplex imaging test, CT scan or MRI to view your cardiovascular system. These tests can help your provider identify the damage in your arteries.


  • Depending on the severity of critical limb ischemia, lifestyle changes such as losing weight, regular exercise and quitting smoking may help to improve your condition.
  • Your provider may also prescribe medication to prevent critical limb-threatening ischemia from worsening. These may include medications to lower blood pressure or cholesterol, alleviate pain and fight infection.
  • If your critical limb-threatening ischemia is more severe, your provider may recommend thrombolysis, in which your provider will give you medication to break down the clot in your blood vessels.
  • Angioplasty, where a surgeon uses a balloon to widen the artery, may be recommended. Alternatively, the surgeon may place a wire stent in the artery to help it maintain adequate blood flow.
  • Bypass surgery may be used to redirect blood flow away from the blockage.
  • In very severe cases of critical limb-threatening ischemia, amputation of the damaged limb or part of the limb may be necessary.

Follow-up Care

  • If you require surgery, the length of your stay in the hospital afterward will depend on the type of surgery performed.
  • Even if you do not have surgery, you will need to make heart-healthy lifestyle choices and closely monitor your cardiovascular health.
  • Your cardiologist will help you maintain a healthy lifestyle and prevent critical limb-threatening ischemia from becoming worse.