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Critical Limb Ischemia (CLI)

What is Critical Limb Ischemia?

Ischemia means blood vessels have become blocked or impeded such that inadequate blood flow goes through. When this happens in the limbs, it can deprive your limbs and extremities of oxygen, ultimately causing tissue death. Critical limb ischemia is a form of peripheral arterial disease (PAD), a circulatory condition where the blood vessels in the legs become narrowed and reduce blood flow. When the blockage becomes severe, it’s known as critical limb ischemia.

Critical limb ischemia is a complex condition that requires a multidisciplinary approach. Not only do the blood vessels need to be revascularized, but any ulcers and tissue death must be also treated appropriately. If left untreated, critical limb ischemia can require amputation. In any case, critical limb ischemia is a serious condition that requires prompt treatment by a vascular surgeon.

Symptoms and Risk Factors

Critical limb ischemia can cause severe pain in the limb, especially when not moving. This is called ischemic rest pain. Other symptoms of critical limb ischemia include:

  • Pain or numbness in the hands, feet, or legs
  • Slow-healing sores
  • Skin discoloration or discharge
  • Dry, smooth, or shiny skin on the limb
  • Thickened nails
  • Weak or no pulse in the hands, feet, or legs
  • Cold feet or hands

If you have PAD, you may develop critical limb ischemia. Other risk factors include critical kidney disease, high blood pressure, high cholesterol, smoking, and diabetes. Men are also more likely to develop critical limb ischemia than women.

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How is Critical Limb Ischemia Diagnosed?

Critical limb ischemia may be diagnosed with an angiogram or a procedure that injects dye into the bloodstream to make it visible during an X-ray. Imaging such as CT scans or ultrasounds may also be used. Once our providers have a clear understanding of the blockage, you’ll discuss prompt treatment options.

Critical Limb Ischemia Treatment Options

Critical limb ischemia requires endovascular treatment to restore blood flow. This is typically done with angioplasty, a minimally invasive procedure that expands the blood vessel and allows for the placement of a stent. Angioplasty can be performed at our comfortable surgical suite as a state-of-the-art outpatient procedure. Additionally, treatment may be needed to address tissue death such as gangrene or ulcers. Our providers will work with your care team to ensure a comprehensive approach.

In some cases, amputation may be needed for critical limb ischemia. This may be as minor as part of a finger or toe, or as major as a whole arm or leg, depending on the progression of the condition. People with diabetes are much more likely to require amputation. In general, about one in every five people with critical limb ischemia require amputation at some point. For this reason, seeking out treatment as soon as possible is essential.

Schedule a Consultation

At South Florida Vascular Associates, we can help you get comprehensive treatment for critical limb ischemia. Meet with our providers during a consultation by calling or filling out our contact form. Our Southeast Florida locations serve the greater Coconut Creek, Boynton Beach, and Plantation areas.


William Julien, MD

Board-Certified Vascular Interventional Physician


Mana Khatkar, PA-C

Certified Physician Assistant


Anissa Rodriguez, NP-C

Certified Nurse Practitioner


Frequently Asked Questions

Is critical limb ischemia life threatening?

Critical limb ischemia can be life-threatening if left untreated. It can increase your risk of other serious medical problems and may even result in death.

What are the 6 signs of limb ischemia?

Six signs of limb ischemia are sometimes referred to as the “six P’s”: pain, pallor (pale skin), pulselessness, paralysis, paresthesia (tingling sensation), and poikilothermia (cold feeling).

What is the pain like in Critical Limb Ischemia?

Patients typically report feelings of pins and needles and a burning pain that tends to worsen at night or when the feet are elevated.

What are the early signs of critical limb ischemia?

Pain or numbness in the lower legs, hands, or feet, skin changes like shiny or dry skin, weaker pulse in the hands and feet, and cold hands and feet are all early signs of critical limb ischemia.