Critical Limb Ischemia

Critical limb ischemia is a severe stage of peripheral artery disease, in which you have significant blockages in the blood flow to your arms, legs or feet. This increases your risk of heart complications. Some people need an amputation to treat critical limb ischemia. The sooner you get treatment, the higher your chances of a good outcome.


What is critical limb ischemia?

Critical limb ischemia is severely blocked blood flow to your one or multiple of your hands, legs or feet. It causes intense pain, numbness and slow-healing sores on your feet, legs or hands. It is a serious condition that increases your risk of heart complications, limb amputation and death.

Critical limb ischemia is a severe stage of peripheral artery disease (PAD). PAD occurs when a fatty substance called plaque (atherosclerotic plaque) builds up inside your arteries and restricts blood flow. It’s harder for your muscles and tissue to remain healthy and strong, or to heal, with limited blood flow. Another name for critical limb ischemia is chronic limb-threatening ischemia.


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Who might get critical limb ischemia?

Anyone with PAD can develop critical limb ischemia. Your risk increases as you get older.

Other risk factors include:

Is critical limb ischemia life-threatening?

Yes. Critical limb ischemia significantly increases your risk of major medical complications, including death. Within one year of developing critical limb ischemia:

  • Almost 1 in 3 people have an amputation.
  • About 1 in 4 people die, most commonly from heart disease or a stroke.


How common is critical limb ischemia?

More than 10% of adults in the United States have critical limb ischemia. The condition affects slightly more men or people assigned male at birth than women or people assigned female at birth.

Symptoms and Causes

What are the symptoms of chronic limb-threatening ischemia?

The most common symptom of chronic limb-threatening ischemia is an intense foot or leg pain. Often, this pain wakes you up at night. You may hang your leg off the edge of your bed or get up and walk around to relieve the pain. Some people don’t feel any pain, but notice other symptoms like the following:

  • Cold hands, feet or legs.
  • Feet that appear smooth, shiny, hairless or very dry.
  • Weak or no pulse in your legs or feet.
  • Numbness in your legs, feet or hands.
  • Slow-healing sores on your feet or legs.
  • Skin discoloration or discharge from gangrene.
  • Thick toenails.


What causes chronic limb-threatening ischemia?

Peripheral artery disease causes chronic limb-threatening ischemia. Chronic limb-threatening ischemia develops when you have narrowed or blocked arteries for months or years.

Diagnosis and Tests

How is critical limb ischemia diagnosed?

Your healthcare provider may suspect critical limb ischemia based on your symptoms and other medical problems. They may use additional tests such as CT scans, MRIs, angiograms or ultrasounds. These tests evaluate:

  • Blood flow in your hands, fingers, ankles, feet and toes.
  • How quickly or thoroughly wounds heal.
  • The extent of narrowed or blocked arteries.

Management and Treatment

How is critical limb ischemia treated?

Critical limb ischemia requires prompt treatment. Restoring proper blood flow to your hands and feet can help reduce the chances that you’ll need an amputation. Your healthcare provider may recommend:

  • Medications to prevent clots, reduce blood pressure and lower cholesterol.
  • Endovascular treatments (minimally invasive), such as angioplasty (placing a stent) to open blocked arteries or atherectomy to remove plaque buildup.
  • Surgery to repair or replace an artery either using one of your own veins or a synthetic replacement.

If none of these treatments adequately restore blood flow, your healthcare provider may need to remove part of your finger, hand, toe, foot or leg. About 1 in 5 people with critical limb ischemia eventually need an amputation. People with diabetes are much more likely to need an amputation.


How can I reduce my risk of chronic limb-threatening ischemia?

You can lower your risk of chronic limb-threatening ischemia by getting treatment for PAD. You may also reduce your risk factors by:

  • Achieving and maintaining an optimal weight for your age, sex and body type.
  • Exercising regularly, incorporating strength training, flexibility and aerobic exercises.
  • Keeping your blood pressure and cholesterol within healthy ranges.
  • Managing any co-existing conditions, such as diabetes.
  • Reducing stress with healthy coping techniques, such as meditation or talk therapy.

Outlook / Prognosis

What is the outlook for chronic limb-threatening ischemia?

Chronic limb-threatening ischemia can lead to serious complications, including a shortened lifespan. If you have any chronic limb-threatening ischemia or PAD symptoms, see a healthcare provider right away. The earlier you get treatment, the less likely you will experience severe complications or need an amputation.

How long can you live with critical limb ischemia?

Critical limb ischemia has high mortality rates. About half of people with the condition live for more than five years after their initial diagnosis. Many people with critical limb ischemia die of cardiac complications or strokes.

Living With

What questions should I ask my doctor?

If you have critical limb ischemia or think you could, you may also want to ask your healthcare provider:

  • What are the early signs of critical limb ischemia?
  • What tests diagnose critical limb ischemia?
  • What are the treatment options for critical limb ischemia?
  • What could happen if I don’t get treatment for critical limb ischemia?
  • How can I reduce my risk of critical limb ischemia if I have PAD?

Additional Common Questions

Can you walk with critical limb ischemia?

Yes. Walking may relieve some of the pain associated with critical limb ischemia. Regular movement and walking also increase blood flow to your legs, which is recommended for critical limb ischemia. If you notice increased pain in your legs with walking, you should talk to your healthcare provider.

A note from Cleveland Clinic

Chronic limb-threatening ischemia occurs when you have severely blocked blood flow to your hands, legs or feet. It is an advanced stage of peripheral artery disease. Critical limb ischemia significantly increases your risk of heart problems and a shorter lifespan. Getting treatment right away improves your chances of a good outcome, including avoiding amputation.

Medically Reviewed

Last reviewed on 05/23/2022.

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