SAVE LIMB SAVE LIFE

To spread awareness about “Critical limb ischemia” (CLI), a condition with severe blockage in the blood vessels that reduces blood flow to hands, feet, and legs. CLI is a severe stage of peripheral arterial disease (PAD) in which the blood supply to the limb is critically low, and if not replenished, amputation is inevitable.

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Professor Dr Digvijay Sharma, HOD Vascular Interventions & Surgery, Fortis Hospitals Delhi, said: “In the starting, the patients start feeling pain during the walk, then gradually the rest pain begins followed by ulcer and gangrene (redness and swelling or loss of sensation).”

Critical limb ischemia (CLI) and what are its management options:

1. What is critical limb ischemia?

 Critical limb ischemia (Reduced blood flow or oxygen supply) or CLI is a condition in which there is a severe blockage in the blood vessels that markedly reduces blood-flow of the extreme such as hands, feet, and legs. It is as Everest age of peripheral arterial disease. In simple terms, this means that the blood supply to the limb is critically low, and if not replenished, amputation is inevitable.

2. What are the typical symptoms of CLI?

It starts with pain on walking and progresses to rest pain, ulcer, and gangrene; vascular surgeons use Rutherford’s ischemia score to stage this condition.

3. What are the risk factors for PAD and CLI?

The risk factors for PAD and CLI include older age, smoking, high cholesterol levels, chronic kidney disease, hypertension, and diabetes. Smoking greatly increases the risk of CLI, so much so that smokers with controlled pressure and sugars are more vulnerable than non-smokers with moderately controlled pressure and sugars.

4. Are patients with CLI at risk for other complications apart from amputation?

Having a CLI makes us more vulnerable to death than even most cancers of stage IV or any heart attack. The above slide clearly explains that a pt with CLI not making it up to 5 years is surpassed only by Lung cancer. This is where our “Save limb save lives” campaign has relevance. If we can mitigate amputations, we do save lives.

5. What are the management options for CLI?

Treatment for CLI can be quite complex and individualised. However, the number one priority is to preserve the limb. Replenishing blood supply is the goal. It varies from supervised exercise with the reduction of risk factors, medicines to facilitate blood flow through narrowed channels, bypass surgery, angioplasty, converting deep veins into arteries, stem cells, et care for all parts of the Limb Salvage Program. Please be clear that the foot has skin, muscles, joints, bones, tendons, nerves, and vessels. This is a complex unit; thus, limb salvage services with Vascular, Plastic are constructive, and Orthopedics along with Endocrinology and foot device specialists give the best outcomes. This is a team effort—the insets how savery good outcome after angioplasty below the ankle.

6. What is stem cell therapy in treating CLI?

 Cell-based therapies have emerged as a new frontier in this direction and are now being considered as a potential newer therapeutic alternative for CLI. Stem cells have great potential for differentiation and evolution into various cell types. The surrounding cellular environment gradually stimulates the stem cells, creating specialised cells that are identical to those with which they come into contact and grow. The effects of this, notably neo angiogenesis, ability to develop into new small blood vessels. As a result, they restore blood circulation and are responsible for these reparative activities.

According to the late st clinical evidence, autologous cell treatment has the potential to favorably alter the natural history of intractable CLI with a superior composite clinical result. It revealed a decrease in amputation risk, an increase in amputation-free survival, enhanced wound healing, and decreased rest pain without altering mortality.

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