Read more: Health, Critical Limb Ischemia, PAD, Diabetes, Stem Cells
BACKGROUND: Critical limb ischemia (CLI) occurs when the arteries in the extremities -- hands, feet and legs -- become severely obstructed, restricting blood flow. The condition often occurs in peripheral arterial disease (PAD) patients and those with atherosclerosis. Many CLI patients also suffer from coexisting diseases like cardiovascular and renal disorders. A large number are also smokers. Symptoms of CLI include pain or numbness in the feet, shiny, smooth, dry skin on the legs or feet, thickening of the toenails, lack of pulse in the legs or feet, open sore and skin infections, and dry gangrene.
DIAGNOSIS: CLI is diagnosed in several ways. In auscultation, using a stethoscope, a doctor listens for a "whooshing" sound in the arteries of limbs. Doppler ultrasound can be performed to measure the direction and velocity of blood flow. An X-ray, or CT angiography, can also be done to produce a 3-D image of the affected areas.
TREATMENT: Some medications may help prevent the disease from progressing and help address contributing factors like high blood pressure, high cholesterol and diabetes, as well as to reduce pain. Anti-clotting drugs and medications for infection may also be administered. Surgery can help restore blood flow to the affected areas. In endovascular procedures, a catheter is inserted into the blocked artery and a small blood vessel is inflated. Plaque may also be scraped away from the artery or a laser may be used to vaporize small bits of plaque. Stents are sometimes left in place to keep the artery open.
In patients in more serious condition, a bypass graft may be ordered, which involves surgically implanting an artificial tube or a patient's vein into the affected area to serve as a new artery. Patients who have had no success with treatment may require amputation. A quarter of all CLI patients succumb to amputation. Diabetic patients suffering from CLI are 10 times more likely to require amputation than diabetes-free CLI patients. Amputation is also greater among patients who smoke heavily.
NEW HOPE: A stem cell therapy for CLI is currently being evaluated by eight medical centers in the United States. For the procedure, a patient's limb is injected with stem cells from their bone marrow. The hope is the stem cells will generate new blood vessels in that area. Studies in India show 87.5 percent of 30 patients treated had their limbs saved. Final results are expected to be published as soon as 2012.
FOR MORE INFORMATION, PLEASE CONTACT:
Margaret Mullins
Media Relations
Roper St. Francis Healthcare
Margaret.mullins@ropersaintfrancis.com
