Critical Limb Ischemia: A Threat to Life and Limb
Jihad A. Mustapha, MD; Barry T. Katzen, MD; Richard F. Neville, MD, FACS; Robert A. Lookstein, MD; Thomas Zeller, MD, PhD; Larry E. Miller, PhD; Vickie R. Driver, DPM; and Michael R. Jaff, DO
Introduction
Peripheral artery disease (PAD) of the lower extremities is a global pandemic of growing proportions. Between 2000 and 2010, the world’s population increased by 12.6%, and the prevalence of PAD has increased twice as much over this period.1 The Global Burden of Disease study reported that 202 million adults worldwide have PAD, a higher prevalence than ischemic heart disease (154 million), heart failure (64 mil-lion), Alzheimer’s disease/dementia (44 million), cancer (43 million), HIV/AIDS (36 million), and opioid addiction (27 million).2 Although most patients with PAD are asymptomatic, the disease increases the risk for cardiovascular morbidity and symptomatic disease progression. Patient prognosis after PAD diagnosis is poor because the disease often progresses to the extent that distal perfusion is insufficient to meet metabolic demands. This advanced PAD is commonly described as critical limb ischemia (CLI) and represents the end stage of the disease, mostly characterized by occlusive disease of the tibial and foot arteries in which patients suffer from rest pain, ischemic ulceration, and/or gangrenous tissue loss.