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Tuesday, February 12, 2013

Do You Have Wounds on Your Feet that Won’t Heal? Seek Medical Attention Immediately



If you have wounds on your feet that won't heal, you may have critical limb ischemia which can lead to the loss of a limb.

Critical limb ischemia (CLI) is the most advanced stage of peripheral artery disease (PAD) and is the leading cause of amputation worldwide. Critical limb ischemia results from a progressive thickening of the lining of an artery caused by a buildup of plaque known as atherosclerosis, which narrows or blocks blood flow reducing circulation of blood to the legs and feet.  If PAD is left untreated, CLI can develop because the leg vessels may become so severe that almost no blood can make it through the vessels to your feet causing the tissue in your feet and leg to become starved of oxygen.  You may feel severe foot pain even at rest, and form ulcers on your legs and feet. In severe cases, tissue can die due to poor circulation, causing gangrene and this can ultimately lead to loss of a limb.  If you have advanced diabetes or kidney disease, you are at particularly high risk of developing CLI.

CLI needs to be treated promptly because the symptoms can progress very quickly.
The goal of treatment is to relieve your pain and allow ulcerations and wounds to heal.  In the case of gangrene, the goal is to remove the dead tissue with subsequent healing of the underlying tissue. Treatment requires aggressive revascularization of blocked arteries as with PAD.  However, because blockages are so advanced in CLI, more advanced techniques are often required.
 The illustration shows how P.A.D. can affect arteries in the legs. Figure A shows a normal artery with normal blood flow. The inset image shows a cross-section of the normal artery. Figure B shows an artery with plaque buildup that's partially blocking blood flow. The inset image shows a cross-section of the narrowed artery.

What can you do to protect yourself?
Stop smoking. Smoking doesn't only increase your risk of cardiovascular disease but it increases your risk of PAD and CLI as well. Women who smoke are at the greatest risk.

Pay attention to the condition of your legs and feet. Are your feet often in pain or numb, especially when elevated? Are your toes slightly blue? Signs of CLI also include shiny, dry skin and thickening toenails.

CLI is closely associated with advanced age, men over 60 and women after menopause. It is also associated with diabetes and kidney disease.

Be aware of symptoms. Ischemic rest pain is a common symptom where legs ache and cramp during exercise or movement. Other symptoms include skin ulcers, lesions and a slow pulse in legs and feet.

CLI is a serious, complex disease that requires a multidisciplinary approach.  At South Florida Vascular Associates we work closely with your primary care physician, wound care physician, and other specialty physicians to provide the comprehensive care needed to treat CLI effectively and preserve the limb.

If you suspect or if you have been diagnosed with CLI, please call our office to schedule an appointment with one of our board certified endovascular surgeons to evaluate your condition and discuss the best treatment plan for you. For your convenience, we have 3 office locations throughout Broward and Palm Beach counties, Coconut Creek, Plantation and Boynton Beach.

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