What is Critical Limb Ischemia (CLI)?

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February 28, 2019


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Critical limb ischemia (CLI) is an advanced form of peripheral artery disease that causes pain, ulcers or gangrene in the affected leg. It most commonly occurs in older people who have conditions that can cause their arteries to become blocked, such as diabetes, high blood pressure, coronary artery disease and chronic kidney disease, according to a study published in the Journal of the American Heart Association (AHA).

The American College of Cardiology (ACC) estimates there will be more than 2.8 million cases of CLI worldwide by next year.

To learn more, the Baptist Health South Florida News Team interviewed Constantino Pena, M.D., an interventional radiologist at Miami Cardiac & Vascular Institute and an expert in treating patients with CLI. Here’s an excerpt:

Q: (Baptist Health) Why is it important to seek better treatment for CLI patients?
A: (Dr. Pena) About 10 million people suffer from arterial occlusive disease which is what leads to CLI. However, considerable efforts are still needed to raise awareness about CLI itself as a disease that needs medical management. Increasing CLI rates pose a significant clinical and financial burden on the healthcare system. Treatment costs per patient, per year, are approximately $50,000 for endovascular or surgical revascularization and nearly $56,000 for major amputation, a recent study found. When we’re able to identify CLI patients early and treating them with standardized treatment plans we can get better results.

Q: What’s the prognosis for a patient with CLI?
A: Unfortunately, most CLI patients have poor prognoses.  Twenty-five percent of patients diagnosed with CLI have to undergo amputation one year of being diagnosed. And only 50 percent are alive with two limbs after one year. The mortality rate at year two after a CLI diagnosis is 40-50 percent. At year four, the 54 percent mortality rate is higher than that of most cancers.

Q: What’s the treatment for CLI?
A: Depending on the stage of disease, the first major treatment for CLI is prompt endovascular revascularization or an open surgical procedure to minimize tissue loss, preserve movement and function and maintain quality of life. Unfortunately amputation if the first line of treatment for patients with severely advanced CLI.

Interventional radiologists at Miami Cardiac & Vascular Institute have a high success rate treating CLI patients with endovascular revascularization. The overall goal is to eliminate resting pain and improve blood flow to the affected area in order to save or preserve the limb or extremity.

Because of the high rate of co-existing diseases that can accelerate CLI symptoms, it’s critical to identify and address these patients early, whether the patient is seen in the emergency room, doctor’s office or while they’re hospitalized for a co-existing condition. And, if warranted, each CLI patient should have post-hospitalization wound care and be monitored for the possibility of needing revascularization.

By remaining vigilantly aware of the possibility of CLI in certain types of patients and using standardized treatments, we can get better results and really make a difference in the progression of this disease.

Q: What are doctors at Miami Cardiac & Vascular Institute doing to further the treatment of CLI?
A: When these patients are not treated appropriately, there’s a huge risk to their life as well as a large cost to the patient and the healthcare system. Two years ago, we committed to increasing awareness about the disease and standardizing treatments. Several of us also participated in a study of CLI Medicare patients to best understand the patients coming to us for treatment. We’ve also learned about the importance of documenting CLI patient data in the electronic medical record and using multidisciplinary team approach to treat them.

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