Critical Limb Ischemia: A Comprehensive Management Challenge

Mrs kamala a 56 year old female has poorly controlled hypertension, chronic kidney disease ( CKD) and dyslipedemia. She presently has continuous moderate pain in her right leg below the knee in general and severe exacerbations of pain in her toe and blackened second right toe. Doppler study showed monophasic flow below popliteal artery and absent flow in dorsalis pedis artery suggesting ischemia of right lower limb.

The above history is suggestive of Critical Limb Ischemia due to reduced blood flow to legs leading to pain and gangrene. It is a kind of severe peripheral vascular disease and needs comprehensive management. The pain typically occurs at rest and wake up an individual at night. It is often relieved by hanging the leg over the bed or walking.

It subsequently returns to normal after exercise ceases.

This patient has dyslipedemia and poorly controlled blood pressure which can lead to atherosclerosis (deposit of plaque in the arteries). This may have reduced the lumen of the arteries, blocked blood flow and reduced the blood flow in the extremities. So, the Doppler study revealed a monophasic blood flow below popliteal artery and absent flow in dorsalis pedis.

Due to obstruction in the arteries, though the resting blood flow is similar to a normal patient, but the flow cannot increase during exercise. So, when the increased demand exceeds the blood flow, there is claudication