Critical limb ischaemia: diagnosis and specialist treatment

Critical lower limb ischaemia is an advanced form of peripheral arterial disease in which blood flow to the foot or leg is severely compromised.

This condition can lead to persistent pain at rest, non-healing wounds or tissue damage requiring specialist assessment.

At the Diabetic Foot and Lower Limb Ischaemia Unit at the Publio Cordón Memorial Hospital, an advanced vascular assessment is carried out to determine whether it is possible to restore arterial circulation using revascularisation techniques and thereby save the limb.

Urgent assessment of blood flow in the leg to prevent serious complications

When blood flow to the limb is significantly reduced, the tissues stop receiving the oxygen they need to remain viable. If circulation is not restored in time, the damage can progress to necrosis or gangrene, increasing the risk of limb loss.

An assessment by specialists in vascular disease allows the situation to be analysed accurately and determines whether circulation can be restored through treatment.

Progression of the disease and risk of limb loss

Critical ischaemia represents the most advanced stage of peripheral arterial disease.

In earlier stages, many people experience pain when walking, which subsides when they stop. As the disease progresses, more serious symptoms may appear, such as pain at rest, foot ulcers or changes in skin colour.

If circulation continues to deteriorate, tissue damage can progress to necrosis or gangrene. In this context, a specialist vascular assessment allows for the possibility of restoring blood flow and preserving the limb to be explored.

Specialist assessment at the Diabetic Foot and Ischaemia Unit

The management of critical ischaemia is based on determining whether it is possible to restore arterial circulation to the limb. Each patient presents a distinct pattern of vascular involvement and a different condition of the tissues; therefore, the therapeutic decision requires an individualised assessment.

Within the Unit, this assessment enables us to determine whether there is an indication for revascularisation and which strategy is most appropriate for limb preservation.

Diagnostic tests to assess arterial circulation

Arterial circulation is assessed through clinical examination and vascular imaging techniques that enable precise analysis of blood flow.

Among the initial tests, the ankle-brachial index is particularly important, as it is useful for detecting blockages in the leg arteries. Arterial Doppler ultrasound enables the localisation of areas of narrowing or blockage and an assessment of their impact.

When treatment is being considered, tests such as CT angiography or arteriography may be used to define the arterial anatomy and plan revascularisation.

When is it necessary to restore blood flow to the leg?

Treatment is aimed at restoring blood flow to the foot and preserving the limb. The decision to treat depends on the extent of arterial involvement, the condition of the tissues and the patient’s clinical condition.

In many cases, restoring circulation helps to relieve pain at rest and promote wound healing.

Treatment to restore blood flow: endovascular techniques and bypass surgery

In many patients, it is possible to restore blood flow through arterial revascularisation procedures. A significant proportion of these treatments are carried out using minimally invasive endovascular techniques, designed to open blocked arteries.

Arterial angioplasty involves widening the artery using a balloon and, in certain cases, placing a stent — a small metal mesh that keeps the artery open — to ensure the flow of blood.

When arterial lesions are more complex, it may be necessary to perform arterial bypass surgery, creating a new channel to redirect blood flow.

Vascular treatment is integrated with specialised care for diabetic foot conditions, infection control and follow-up by multidisciplinary teams.

How is lower limb arterial angioplasty performed?

The procedure is carried out in a specialised setting with real-time imaging. At the Publio Cordón Memorial Hospital, these procedures are performed in a hybrid operating theatre, which combines advanced angiography technology with the facilities of a vascular operating theatre.

The procedure is usually carried out via a puncture in the groin, through which catheters are inserted to access the affected arteries and treat them from the inside. In most cases, it is performed under local anaesthetic and sedation, which facilitates a quicker recovery.

Follow-up and recovery following revascularisation

Following treatment, clinical follow-up enables the progress of blood flow to be assessed and the healing of lesions to be monitored. Regular check-ups are also essential for monitoring the progression of vascular disease and optimising the management of cardiovascular risk factors.

Ongoing care provided by specialist teams enables the early detection of potential complications and supports the patient’s recovery.

Timely therapeutic decision-making

Critical ischaemia is a serious condition, but in many patients it is possible to restore circulation when a specialist assessment is carried out in good time.

An accurate diagnosis and individualised treatment planning enable the condition to be managed with an approach aimed at preserving the limb and improving quality of life.