PERIPHERAL VASCULAR DISEASE (PAD)

How is CLTI different from simple PAD?

• PAD: Pain while walking (claudication), relieved by rest

• CLTI:

  • Pain even at rest (especially at night)

  • Non-healing ulcers or wounds

  • Blackening of toes or foot (gangrene)

  • High risk of limb loss if untreated

CLTI is a medical and surgical emergency.

What causes CLTI?

Common causes include:

• Diabetes

• Smoking

• High blood pressure

• High cholesterol

• Kidney disease

• Old age

What symptoms suggest CLTI?

• Severe leg or foot pain at rest

• Pain worse at night, relieved by hanging the leg down

• Non-healing foot ulcers

• Black or dead skin on toes or foot

• Cold, pale, or numb foot

How is CLTI diagnosed?

Doctors use:

• Clinical examination (pulse check, wound assessment)

• Doppler ultrasound

• CT angiography or MR angiography

• Blood tests to assess infection and general health

Why is treatment urgent in CLTI?

Without treatment:

• Wounds do not heal

• Infection spreads to bone

• Gangrene develops

• Major amputation may become unavoidable

• Risk of heart attack and stroke increases

Early treatment aims to save the limb and life.

What are the treatment options for CLTI?

Treatment depends on severity and artery involvement:

1. Best medical therapy (drugs, wound care)

2. Endovascular procedures (angioplasty/stenting)

3. Surgical bypass

4. Amputation (last resort)

What is surgical bypass surgery in CLTI?

Surgical bypass is an operation where blood flow is rerouted around a blocked artery using:

• The patient’s own vein (preferred)

• Or a synthetic graft

This creates a new pathway for blood to reach the foot.

When is surgical bypass advised?

Bypass surgery is recommended when:

• Blockages are long or multiple

• Angioplasty is not suitable or has failed

• There is severe tissue loss or gangrene

• Patient is fit enough for surgery

What are the goals of bypass surgery?

• Restore blood flow to the foot

• Heal ulcers and wounds

• Relieve rest pain

• Prevent amputation

• Improve quality of life

How successful is bypass surgery?

• Good blood flow is restored in most patients

• Limb salvage rates are high when done early

• Wounds usually start healing within weeks

• Pain at rest often disappears quickly

Success depends on:

• Quality of blood vessels

• Diabetes control

• Smoking cessation

• Proper wound care

What are the risks of bypass surgery?

Possible risks include:

• Wound infection

• Graft blockage

• Heart or lung complications

• Bleeding

Despite risks, bypass surgery often saves the limb when no other option works.

What happens after surgery?

• Regular follow-up visits

• Doppler checks of the graft

• Long-term blood-thinning medicines

• Strict control of diabetes, BP, cholesterol

• Foot care and wound monitoring

What are the long-term outcomes of CLTI after bypass?

• Many patients keep their limb

• Walking ability improves

• Quality of life increases

• Risk of repeat procedures exists

• Lifelong care is required to protect the graft

Can CLTI be prevented?

Yes, by:

• Quitting smoking

• Controlling diabetes

• Regular foot examination

• Early treatment of PAD

• Healthy diet and activity

Key message

Chronic Limb-Threatening Ischaemia is a serious but treatable condition.
Timely diagnosis and surgical bypass can save the limb and improve survival, especially when combined with good medical care and lifestyle changes.