Vascular Medicine Conference-CVC 2026

Critical Limb Ischemia (CLI) stands as the most severe manifestation of Peripheral Artery Disease (PAD), characterized by profound arterial blockages that drastically diminish blood flow to the lower extremities. Unlike intermittent claudication, where discomfort arises during physical activity, CLI presents with persistent pain in the feet or toes even at rest. This unrelenting pain frequently coincides with non-healing ulcers or the development of gangrene, signifying a true medical emergency with a substantial risk of limb loss or amputation if not addressed expeditiously.

The pathogenesis of CLI is strongly associated with established risk factors, including tobacco use, diabetes mellitus, elevated cholesterol, hypertension, obesity, and advancing age—all of which contribute to the progression of atherosclerotic disease. Diagnostic evaluation typically encompasses clinical assessment supplemented by objective studies such as the ankle-brachial index (ABI), Doppler ultrasound, computed tomography or magnetic resonance angiography, and, in certain cases, catheter-based angiography to delineate the extent and specific location of arterial occlusion.

Therapeutic strategies for CLI focus on revascularization to restore perfusion, alleviate pain, and preserve limb viability. Management may involve pharmacologic control of risk factors, structured exercise programs, and advanced endovascular or surgical interventions, including angioplasty, stent placement, atherectomy, or bypass grafting. In situations where irreversible tissue necrosis has occurred, amputation may be necessary to prevent systemic infection and optimize patient outcomes.

Optimal management of CLI necessitates a multidisciplinary team, integrating expertise from vascular surgery, wound care, and lifestyle modification counseling. Early recognition and aggressive intervention are vital to improving limb salvage rates, minimizing complications, and enhancing overall survival. With prompt medical attention and comprehensive risk factor management, many individuals with CLI can maintain mobility and achieve significant improvements in vascular health.