Vascular Condition
Limb Salvage
Critical limb ischaemia (CLI) is the most severe stage of peripheral arterial disease, where blood supply to the limb is critically reduced, causing rest pain, non-healing ulcers, or gangrene. Without revascularisation, major amputation is often the outcome. Limb salvage surgery aims to restore adequate blood flow and preserve the limb.
Symptoms
- Severe pain in the foot or toes at rest, especially at night
- Non-healing wounds or ulcers on the foot or lower leg
- Gangrene (blackening or tissue death) of the toes or foot
- Coldness, pallor, or mottling of the foot
- Absent pulses in the foot
Causes & Risk Factors
- Advanced peripheral arterial disease
- Diabetes mellitus with arterial disease
- End-stage renal disease
- Thromboembolism to a lower limb artery
- Buerger's disease (thromboangiitis obliterans)
Treatment
Revascularisation is the cornerstone of limb salvage. Options include endovascular procedures (angioplasty, stenting, atherectomy) and surgical bypass grafting. The choice depends on the location and extent of arterial disease and the patient's overall fitness.
Recovery & Aftercare
Recovery depends on the complexity of the revascularisation and the wound status at the time of treatment. Early intervention, before extensive tissue loss, gives the best outcomes.
Frequently Asked Questions
Not necessarily. With specialist assessment and timely revascularisation, a significant proportion of patients with CLI can have their limbs saved. Early referral is the key.
Bypass surgery typically takes two to four hours depending on complexity. Hospital stay is usually five to seven days.
When to Seek Medical Advice
- Any rest pain in the foot — urgent assessment is required
- Foot ulcer not responding to treatment
- Gangrene or blackening of toes or foot — urgent referral needed