Limb Ischaemia (Ischemia): Symptoms, What It Is and Treatment
Author MUDr. Peter Bednarčík CSc.
Revision
Do your feet feel cold or do you sometimes limp? Do your feet hurt and the pain subsides after stopping and resting for a short time? Ischaemic limb disease is characterised by these problems. Ignoring them can lead to major damage to the limb and, in the most severe cases, to amputation.
Find out how to recognize the symptoms of limb ischemia, and what the causes and treatment options are. Know how to combat symptoms such as pain, inflammation and reduced blood flow that accompany this condition? [1] Read more here.
Ischaemia symptoms
Ischaemia symptoms vary depending on whether it is acute or critical ischemia.
Acute limb ischaemia has the following symptoms:
- Pain in the limb that gradually worsens,
- pale skin on the limb,
- cold limb,
- deterioration or disappearance of the pulse in the limb,
- numbness. [2]
Critical ischemic limb disease and its symptoms:
- Pain in the limb at rest,
- ulcers or open infected wounds,
- shiny, smooth and dry skin on the feet,
- pulse changes in the limb,
- dry gangrene (tissue that dries out and turns black due to impaired blood supply). [3]
Ischemia of the limbs may also be manifested by occasional lameness (claudication).
Only a doctor can make a correct diagnosis. Do not use this or any other article on the internet to make a diagnosis. Do not delay seeing a doctor, and address your condition early.
Description and causes of limb ischemia
Ischemia – what is it?
Ischemia is the name given to a condition in which certain tissues or organs do not survive and become damaged. The essence of ischemia is a lack of oxygen and nutrients in the tissues. Ischemia can affect the legs (lower limb ischemia), hands, heart or brain. [5]
- Acute ischemia of the lower limbs – sudden and rapid deterioration of blood circulation in the legs or complete loss of pulse in the lower limbs.
- Critical ischemia – an advanced stage of peripheral artery disease that disrupts blood circulation in the lower limbs.[6]
Ischemic limb disease - photo gallery
Limb ischaemia - causes of the disease
Acute ischemia of the lower limbs is usually related to thrombosis (blood clots forming in blood vessels). The typical cause of thrombosis is atherosclerosis, the formation of plaques in blood vessels.
- Some cases of acute ischemia are caused by embolism (a wedging of an embolus, that is, a mass of blood or fatty tissue in the blood vessels).
- Less common causes are injuries or cyst formation. [7]
The cause of critical ischemia is peripheral vascular disease, which occurs when fatty particles accumulate in blood vessels. [8]
Diagnosis of limb ischemia
A careful analysis of the patient’s general health (personal history), a physical examination and a Doppler ultrasound are important in establishing the diagnosis of lower limb ischemia.
Angiography (X-ray examination of blood vessels with a contrast medium), magnetic resonance imaging (MRI) or computed tomography (CT) are used. [9]
The measurement of peripheral pressures and the determination of the ankle-brachial index (ABI) will provide essential information. [10]
The doctor may also use an ECG to diagnose the heart or send the patient for a blood test. [11]
Did you know?
- Between 15% and 20% of people who report claudication (limping) develop critical ischaemia during their lifetime.
- Patients with claudication who are also treated for diabetes have a risk of critical limb ischemia up to 10 times higher.
- If the limb ischaemia is not treated and revascularisation does not occur, the risk of amputation of the limb within one year is up to 95%. [12]
Limb ischaemia - what is the prognosis and possible complications
- Critical limby ischaemia disease can bring serious health complications, including limb amputation, and shortened life expectancy.
- Therefore, the earlier a patient with symptoms of ischaemia is treated, the lower the risk of associated complications.
- Approximately half of patients with this disease live longer than five years after diagnosis.
- A common cause of death in patients with critical ischemia is various cardiac complications or stroke. [13]
Amputation
Heart complications
Cerebrovascular stroke
Faster progression of ageing
We recommend not delaying treatment of limb ischemia
Do not delay treatment for limb ischemia, and see a specialist if you have any health problems or doubts about your health. This will prevent unnecessary health complications.
Treatment of ischemia
Acute limb ischaemia, like critical ischemia, requires immediate medical intervention. The aim of treatment, which often involves specialists from different disciplines, is to restore blood flow to the affected area and preserve a functional limb. Restoring the vascular supply is called revascularisation. [14][15]
In critical ischemia, various surgical methods of treatment are used.
- Angioplasty – the reconstruction of a blood vessel in which a small balloon is inserted into the body to make the blood vessel permeable.
- Angioplasty with the insertion of a stent that “reinforces” the damaged artery.
- Endarterectomy – a procedure in which part of the artery and the atherosclerotic plaque are removed.
- Bypass – “bridging” a narrowed or closed artery with another blood vessel from the patient’s body or artificial material. [16]
Conservative methods of treatment include:
- Elimination of risk factors (quitting smoking, losing weight, maintaining proper blood pressure),
- proper treatment of associated diseases (such as diabetes or high blood pressure),
- taking medicines that reduce the risk of heart and vascular disease. [17]
Acute limb ischaemia – treatment
Acute ischemia of the leg is treated in different ways.
- Endovascular treatment involves surgical procedures on the arteries (such as angioplasty) and dissolving blood clots.
- Anticoagulant (anticoagulant) treatment involves the administration of anti-clotting drugs. In some cases, different treatments are combined in different ways. [18]
Conservative treatment involves giving heparin (a substance to reduce blood clotting) in infusions, hydrating (watering) the patient or giving painkillers. [19]
Beware
Treatment for lower limb coronary artery disease can only be determined by your doctor after considering your overall health. Therefore, do not use this article as a guide to treatment, which can only be determined by your doctor.
Prevention of ischemia
The risk of limb ischaemia can be reduced by preventive measures similar to those for cardiovascular disease. Doctors recommend:
- quitting smoking,
- reduce cholesterol levels,
- maintain proper blood pressure,
- adhere to the treatment of diabetes,
- maintain a healthy lifestyle, including regular exercise. [20]
Chronic ischemic disease of the lower limbs: physiotherapy
Physical activity plays an important role in patients with limb ischemia. Appropriate activity promotes circulation, mobility and muscle strength and is an integral part of conservative treatment. The type of exercise, its intensity and frequency can be recommended by the physiotherapist, unless the patient’s medical condition prevents it.
- Recommended activities include walking on a treadmill or riding a stationary bike.
- Exercise targeting the upper limbs improves overall performance.
- Physiotherapists also use methods to promote blood microcirculation.
- Patients can try electrotherapy, magnetotherapy and hydrotherapy. [21]
Alternative treatments for limb ischemia
- Massage – can relieve pain, discomfort and promote blood flow. However, they should only be performed by an experienced massage therapist with a doctor’s approval due to the risk of deep vein thrombosis. [22]
- Acupuncture – some studies point to the effect of acupuncture, which improves blood flow and oxygenation in treated parts of the body. [23]
- Herbs – Herbal remedies can play a beneficial role in the prevention of vascular diseases or support their treatment. For example, ginkgo biloba is used to support peripheral circulation. The choice of herbal preparations should be consulted with a physician. [24]
Important information when dealing with limb ischemia
In ischemic limb disease, some parts of the limbs do not circulate as much as they need to and damage occurs.
The disease is characterized by a high mortality rate, so symptoms of ischemia must be addressed immediately with a physician.
Treatment of ischemia is both conservative and surgical. The aim is to restore blood flow in the affected area.
Summary and recommendations for managing ischaemic disease of the limbs
See your physician
Treatment for limb ischaemia is always determined by your doctor based on a general examination, an assessment of your condition and an accurate diagnosis.
Causal treatment of ischaemic disease of the limbs
After a general examination, your doctor will recommend treatment. In connection with this, they will also recommend possible lifestyle modification and further courses of action.
Relieving pain, swelling and inflammation
Symptomatic treatment focuses on the manifestations or symptoms of the disease. Such treatment can significantly improve your quality of life and support comprehensive treatment as the disease progresses.
Sources, references and literature
[1] Shishehbor M. H. Acute and critical limb ischemia: when time is limp. Cleve Clin J Med. 2014 Apr;81(4):209-216, doi: 10.3949/ccjm.81gr.13003. Available at: https://www.ccjm.org/content/ccjom/81/4/209.full.pdf
[2] Cunha J.P. What Is Critical Limb Ischemia (CLI) vs. Acute Limb Ischemia? eMedicineHealth, 19. November 2021. Available at: https://www.emedicinehealth.com/critical_limb_ischemia_cli_vs_acute_limb_ischemia/article_em.htm
[3] Cunha J.P. What Is Critical Limb Ischemia (CLI) vs. Acute Limb Ischemia? eMedicineHealth, 19. November 2021. Available at: https://www.emedicinehealth.com/critical_limb_ischemia_cli_vs_acute_limb_ischemia/article_em.htm
[4] Medical Dictionary of Health Terms: D-I. Harvard Health Publishing, Harvard Medical School. °13. December 2011. Available at: https://www.health.harvard.edu/d-through-i#I-terms
[5] Shishehbor M. H. Acute and critical limb ischemia: when time is limp. Cleve Clin J Med. 2014 Apr;81(4):209-216, doi: 10.3949/ccjm.81gr.13003. Available at: https://www.ccjm.org/content/ccjom/81/4/209.full.pdf
[6] Cunha J.P. What Is Critical Limb Ischemia (CLI) vs. Acute Limb Ischemia? eMedicineHealth, 19. November 2021. Available at: https://www.emedicinehealth.com/critical_limb_ischemia_cli_vs_acute_limb_ischemia/article_em.htm
[7] Shishehbor M. H. Acute and critical limb ischemia: when time is limp. Cleve Clin J Med. 2014 Apr;81(4):209-216, doi: 10.3949/ccjm.81gr.13003. Available at: https://www.ccjm.org/content/ccjom/81/4/209.full.pdf
[8] Cunha J.P. What Is Critical Limb Ischemia (CLI) vs. Acute Limb Ischemia? eMedicineHealth, 19. November 2021. Available at: https://www.emedicinehealth.com/critical_limb_ischemia_cli_vs_acute_limb_ischemia/article_em.htm
[9] Acute Limb Ischaemia. Emergency Care Institute, New South Wales. Available at: https://aci.health.nsw.gov.au/networks/eci/clinical/clinical-tools/vascular-emergencies/acute-limb-ischaemia
[10] Cunha J.P. What Is Critical Limb Ischemia (CLI) vs. Acute Limb Ischemia? eMedicineHealth, 19. November 2021. Available at: https://www.emedicinehealth.com/critical_limb_ischemia_cli_vs_acute_limb_ischemia/article_em.htm
[11] Acute Limb Ischaemia. Emergency Care Institute, New South Wales. Available at: https://aci.health.nsw.gov.au/networks/eci/clinical/clinical-tools/vascular-emergencies/acute-limb-ischaemia
[12] Shishehbor M. H. Acute and critical limb ischemia: when time is limp. Cleve Clin J Med. 2014 Apr;81(4):209-216, doi: 10.3949/ccjm.81gr.13003. Available at: https://www.ccjm.org/content/ccjom/81/4/209.full.pdf
[13] Critical Limb Ischemia. Cleveland Clinic, 23. May 2023. Available at: https://my.clevelandclinic.org/health/diseases/23120-critical-limb-ischemia
[14] Shishehbor M. H. Acute and critical limb ischemia: when time is limp. Cleve Clin J Med. 2014 Apr;81(4):209-216, doi: 10.3949/ccjm.81gr.13003. Available at: https://www.ccjm.org/content/ccjom/81/4/209.full.pdf
[15] Cunha J.P. What Is Critical Limb Ischemia (CLI) vs. Acute Limb Ischemia? eMedicineHealth, 19. November 2021. Available at: https://www.emedicinehealth.com/critical_limb_ischemia_cli_vs_acute_limb_ischemia/article_em.htm
[16] Cunha J.P. What Is Critical Limb Ischemia (CLI) vs. Acute Limb Ischemia? eMedicineHealth, 19. November 2021. Available at: https://www.emedicinehealth.com/critical_limb_ischemia_cli_vs_acute_limb_ischemia/article_em.htm
[17] Santilli J. D., Santilli S. M. Chronic critical limb ischemia: diagnosis, treatment and prognosis. Am Fam Physician. 1999 Apr 1; 59(7): 1899-1908. Available at: https://www.aafp.org/pubs/afp/issues/1999/0401/p1899.html
[18] Cunha J.P. What Is Critical Limb Ischemia (CLI) vs. Acute Limb Ischemia? eMedicineHealth, 19. November 2021. Available at: https://www.emedicinehealth.com/critical_limb_ischemia_cli_vs_acute_limb_ischemia/article_em.htm
[19] Lukasiewicz A. Contemporary Management of Acute Lower Limb Ischemia: Determinants of Treatment Choice. J Clin Med. 2020 May 16; 9 (5): 1501, doi: 10.3390/jcm9051501. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291168/
[20] Shishehbor M. H. Acute and critical limb ischemia: when time is limp. Cleve Clin J Med. 2014 Apr;81(4):209-216, doi: 10.3949/ccjm.81gr.13003. Available at: https://www.ccjm.org/content/ccjom/81/4/209.full.pdf
[21] Spannbauer A., Chwała M., Ridan T. et al. Intermittent Claudication in Physiotherapists’ Practice. Biomed Res Int. 2019 Sep 18; 2019:2470801, doi: 10.1155/2019/2470801. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6766680/
[22] Massage for Peripheral Artery Disease. The Medical Massage Lady, 7. November 2022. Available at: https://www.themedicalmassagelady.co.uk/blog/massage-for-peripheral-artery-disease.html
[23] Suzuki S., Ichioka S., Omata H. et al. Effects of Acupuncture on Lower Limb Ischemia. J Saitama Medical University 2009; 36: 1-10. Available at: https://www.saitama-med.ac.jp/jsms/vol36/01/jsms36_001_010.pdf
[24] Wong C. Remedies for Peripheral Artery Disease. Verywell Health, 28. October 2021. Available at: https://www.verywellhealth.com/natural-remedies-for-peripheral-artery-disease-88856
How to control pain, swelling and address inflammation?
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