A header graphic for Critical Limb Ischemia (CLI) with a sytlized angiograph

Have you, or someone you know, had a sore on their foot that just would not go away? Critical Limb Ischemia (CLI) is the result of narrowing arteries in the leg, which restricts blood flow to your extremities. You may first notice CLI as pain in the foot or an ulceration on the toe.

Article reviewed by Luke Wilkins, MD and John Angle, MD.

About Critical Limb Ischemia (CLI)

Ischemia is a condition in which there is inadequate blood flow to some part of the body. Any limb or organ can be affected by this condition. Ischemia is usually the result of atherosclerosis, a condition where plaque, made up of fat, fibrous material, and calcium, builds up in the artery wall, causing them to stiffen and narrow, restricting blood flow.

Critical Limb Ischemia (CLI) is an advanced form of ischemia characterized by a near-complete loss of blood flow to one or both legs, but it can sometimes affect the arms as well. CLI is most often identified by its symptoms, most frequently, pain in the foot and calf that is sometimes relieved by dangling the leg off the side of the bed. Left untreated the skin can turn blue and sores called ulcers can develop. Severe cases can suffer irreversible damage the foot due to a condition called gangrene, a death of body tissue.

Symptoms and Risk Factors

The risk factors for CLI are almost identical to those of atherosclerosis, heart attack, PAD, and stroke. By controlling  your risk factors, you can take steps to limit their effect on your arteries and prevent CLI later in life.

Risk Factors

  • Being over the age of 55
  • Smoking
  • Diabetes
  • Obesity
  • Sedentary lifestyle
  • High cholesterol
  • High blood pressure

Symptoms of CLI include:

An infographic with the 6 signs of CLI: severe pain in extremities while resting; sores on extremities that won't heal; extremities that are much colder than the rest of the body; abnormally smooth, dry, or shiny skin; weak or absent pulse; and gangrene

  • Severe pain or numbness in the affected limb
  • Sores on the affected limb that won’t heal, or heal very slowly
  • Affected limb is much colder than the rest of the body and may appear red or blue
  • Abnormally smooth, dry, shiny skin
  • Pulse is weak or absent
  • Gangrene


Diagnosing CLI depends mainly on what you have noticed and the examination of your foot.  Your healthcare provider will run through a number of questions to determine the cause of your symptoms and measure your blood pressure in all four extremities. Your doctor may order other tests to examine the extent of atherosclerosis such as CT, MRI, or ultrasound.  If CLI is suspected, your doctor will likely order an angiogram, an map of your blood vessels made using a special dye and x-ray.

A stylized graphic of an angiogram

A stylized graphic of an angiogram.


Many patients will need a balloon or stent as part of that angiogram. Others may need a bypass, a procedure to replace damaged arteries.

Medication and Exercise

In early stages of CLI, the disease may be able to be treated with medication and an exercise routine set and supervised by your doctor.

Minimally Invasive Procedures

One of the most common treatments for CLI is angioplasty. During an angioplasty procedure, vascular specialists (such as interventional radiologists) access narrowed or blocked arteries and inflate a small balloon inside the artery to widen it, allowing normal blood flow to return. In some angioplasty procedures, it may be necessary to place a scaffold, called a stent, to keep the artery open. In some situations, atherectomy may also be performed to actually remove some of the atherosclerotic material from wall of the narrowed artery. The process can remove a significant amount of disease from the artery, but still a balloon and often a stent are still required.


In very long atherosclerotic blockages an open surgical bypass may be the best option. During a bypass surgery, the surgeon uses a vein segment from another part of your body (or artificial tubing) to make a path for blood to go around the blocked artery, delivering blood flow to the affected extremity. Bypass isn’t the only surgical option, but the types of surgeries that are available vary between patients and hospitals.


Preventing CLI mainly comes down to preventing the main cause of the condition–atherosclerosis. Maintaining a healthy diet is the easiest and most important way to prevent atherosclerosis. Getting treated for high cholesterol or high blood pressure and exercising regularly are also good ways to prevent or at least slow down the development of atherosclerosis. It is important to discuss your exercise routine with your primary care doctor or your cardiologists prior to performing any vigorous exercise.

If you have symptoms of CLI, talk to your doctor today about screening. If you have CLI, contact UVA Interventional Radiology at 434.924.9401 to set up an appointment.

Related Posts

Leave a Comment