Critical Limb Ischemia (CLI)

Lady rubbing sore feetWhat is Critical Limb Ischemia?

CLI is an urgent condition caused by chronic blockages of the arteries which significantly reduces blood flow to the legs, hands and feet. This type of poor circulation can cause severe pain in your feet, toes and hands, even while resting. Complications of poor circulation can include sores and wounds that won’t heal. Left untreated, you are at high risk for skin breakdown, infection, and even amputation of the limb.

CLI is a very severe condition of peripheral artery disease (PAD) and needs immediate comprehensive treatment to prevent limb loss and to improve your quality of life. This condition will not improve on its own.


Critical limb ischemia is the advanced stage of peripheral artery disease (PAD), which results from a progressive thickening of an arteries lining (caused by a buildup of plaque). This buildup of plaque, also known as atherosclerosis, narrows or blocks blood flow, reducing circulation of blood to the legs, feet, or hands. The risk factors for critical limb ischemia include:

  • Age (Men over 60 and women after menopause)
  • Smoking
  • Diabetes
  • Overweight or obesity
  • High cholesterol
  • High blood pressure
  • Sedentary lifestyle
  • Family history of vascular disease

Signs and Symptoms:

You may have critical limb ischemia if you have any of the following symptoms:

  • Severe pain or numbness in the legs and feet while not moving known as rest pain
  • Toe or foot sores, infections or ulcers that will not heal or heal very slowly
  • Gangrene
  • A noticeable decrease in the temperature of your lower leg or foot compared to the rest of your body
  • Thickening of the toenails
  • Absent or diminished pulse in the legs or feet


Critical limb ischemia is a serious condition that requires immediate treatment to re-establish blood flow to the affected area or areas. Treatment for CLI can be quite complex and individualized, but the overall goal should always be to reduce the pain and improve blood flow to save the leg or arm. The number one priority is to preserve the limb. 

What to Expect at Your Visit

During your visit, you will receive a coordinated, comprehensive assessment by each member of our multidisciplinary team in effort to determine potential options for improving your blood flow, aggressively treating any wounds, and reducing other risk factors that might be worsening your condition. The complete assessment will take several hours, so please plan to spend the afternoon in the clinic.

Learn Your Risk

Take an online Heart Aware, Vascular Aware or PAD Aware assessment to discover your odds of developing a cardiovascular disease. You’ll find out if you qualify for further screenings or consultations.

North Carolina Heart & Vascular Hospital

Dr Usher - NC Heart HospitalWe built the North Carolina Heart & Vascular Hospital for many reasons. To bring the most advanced technology to our community. To gather top specialists in one location. To teach others how to lead heart healthy lives. But the best reasons are our patients.

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