An unobstructed flow of nutrient-rich blood is necessary for preventing both heart and vascular diseases, and it is the vital link they share. But it’s vascular disease that usually gets less attention, and that why September marks National Vascular Disease Awareness Month.

Vascular diseases, which include arterial disease, venous disease, and blood clots, is a leading cause of death around the world, as is heart disease. Vascular disease covers any condition that affects the circulatory system. Peripheral artery disease, or PAD, is the most commonly diagnosed vascular disease, but PAD is typically underdiagnosed. PAD can have no symptoms, but it’s important to diagnose.

And there’s critical limb ischemia (CLI), which results from inadequate blood flow to the legs and feet caused by atherosclerosis, or plaque buildup, in the arteries that supply blood to these lower extremities. When tissues of the legs and feet are robbed of oxygen-rich blood, they can become painful, heal slowly and eventually die, setting up the need for amputation. Yet, beyond disabling victims, CLI can lead to death. CLI is a form of PAD.

Global Epidemic of CLI

There’s a growing worldwide epidemic CLI that threatens to disable approximately 2 million Americans. Miami Cardiac & Vascular Institute has been at the forefront of CLI research, along with other U.S. cardiovascular centers.

CLI is commonly seen in patients with diabetes, chronic kidney disease and hypertension, or high blood pressure.

“Critical limb ischemia is a preventable cause of amputation,” explains Constantino Pena, M.D., an interventional radiologist and Medical Director of Vascular Imaging at Miami Cardiac & Vascular Institute. “At Miami Cardiac & Vascular Institute, we focus on a multidisciplinary approach to treat our patients in order to prevent and minimize amputation. Medications, wound care, and minimally invasive therapies continue to expand to help us reach our ultimate goal to prevent patients from losing their limbs.”

Age, family history of vascular disease, obesity, a sedentary lifestyle, and key underlying health conditions, including diabetes, can increase your risk for vascular disease, including PAD and CLI.

Barry Katzen, M.D., an interventional radiologist who treats patients with CLI and is the founder and chief medical executive of Miami Cardiac & Vascular Institute has taken on another role to raise awareness about this deadly condition. Dr. Katzen also serves as president of the CLI Global Society Board.

“Through research we, at Miami Cardiac & Vascular Institute, and others have been involved with, we’ve found that the five-year death rate of people diagnosed with CLI is higher than many of the deadliest cancers, including pancreatic, colorectal, liver and breast cancer,” Dr. Katzen said. A study he co-authored in 2018, published in the Journal of the American Heart Association, found that the mortality rate of people five years past diagnosis of CLI was 60 percent.

Dr. Katzen credits the high mortality rate to a lack of awareness by the public and many doctors about CLI, diagnosis and treatment options. By the time most people are diagnosed with the disease, aggressive intervention is needed.  

“Generally, this disease affects people in their 60s and beyond, when disease processes like atherosclerosis, hypertension and diabetes begin to take their toll on our vascular health,” he said. “It’s important to recognize the signs of critical limb ischemia.”

Diagnosing Critical Limb Ischemia

The most common test to determine whether there may be a blockage in an artery to the legs is a non-invasive test called an ankle-brachial index. The test compares the blood pressure in the legs to the blood pressure in the arms. If the blood pressure is weaker in the legs, the ankle-brachial index is low and blood flowing to the ankles may be encountering resistance along its path to the feet. If the ankle-brachial index reveals this phenomenon, a test to measure the amount of or visualize the path of the blood flow through the blood vessels, such as an ultrasound or an angiogram using a computerized tomography (CT) scan or magnetic resonance imaging (MRI) technology, along with more extensive functional analysis of the blood flow, can confirm CLI.   

Treating CLI

For some individuals with advanced CLI that has led to gangrene or tissue death, amputation may be necessary. But, in many cases, there are treatment options that don’t involve such drastic and disabling measures.

“We now have the technology and the expertise of more than 15 years of studying this disease to know that endovascular or surgical revascularization is an option for some people,” said Dr. Katzen. “It also has been proven to extend life expectancy and improve morbidity by reducing the need for amputation.”