Critical Limb Ischemia

Critical limb ischemia (CLI) is defined by the presence of ischemic resting pain in the distal foot, ischemic nonheal-ing ulcerations, or gangrene, and represents less than 10% of patients with PVD (Hiatt, 2001). Although this subset represents the smallest percentage of patients with PVD, these patients have tremendous disease burden and are clearly the highest risk subset for morbidity and mortality, with up to 73% to 95% progressing to limb loss or death at one year if left untreated (Wolfe and Wyatt, 1997). Each year 150,000 to 200,000 nontraumatic lower extremity amputations are performed in the United States, 85% to 90% of which could be avoided through early revascularization and aggressive risk factor management. Amputation carries a high rate of long-term morbidity and mortality. The fate of the amputee is poor, particularly in the elderly. The level of amputation also dictates the overall prognosis; two to three times as many below-the-knee (BK) amputees achieve full mobility compared to above-the-knee (AK) amputees, but the initial rehabilitation may take up to 9 months. In addition, 5 years after a BK amputation, 30% of patients will have had a major contralateral amputation, 50% will be dead, and only 20% will be alive with one leg intact (Dormandy and Rutherford, 2000).

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