Chronic Threatening Limb Ischemia - CTLI is one of the vascular diseases that affect population and health socio-economical systems. - Introduction - Definition - Classifications - Causes - Risk Factors - Symptoms - Diagnosis - Management - Rehabilitation

1. Chronic Threatening
Limb Ischemia (CTLI)
Dr. KHALID ALRAJHI
Consultant of Vascular & Endovascular Surgery
Lead of Vascular Surgery - Ministry of Health - Jazan Province
TOT General Surgery Residency - Vascular Surgery Fellowship
Programs, SCFHS – Saudi Arabia
@khalidalrajhi9
www.linkedin.com/in/khalid-alrajhi

2. Introduction
• Chronic threatening limb ischemia (CTLI) is a
severe manifestation of peripheral artery disease
(PAD) that results from the chronic obstruction of
blood flow to the lower extremities.
• CTLI is a critical condition that can lead to tissue
damage, ulceration, and gangrene, and ultimately,
amputation if left untreated.
• Early diagnosis and treatment are crucial to
prevent complications and improve outcomes.
• The prevalence of PAD and CTLI increases with
age and is more common in men than women.
• The incidence and prevalence of CTLI are less well
defined but are estimated to affect 1-3% of
patients with PAD.

4. Causes and Risk Factors
• Atherosclerosis is the main
cause of CTLI.
Atherosclerosis is a chronic
inflammatory condition that
results from the buildup of fatty
deposits, cholesterol, and other
substances in the walls of
arteries, leading to the formation
of plaques. The plaques can
narrow or block the arteries,
reducing blood flow to the lower
extremities.
• Smoking is the most significant
modifiable risk factor for PAD
and CTLI, as it causes oxidative
stress, inflammation, and
endothelial dysfunction, leading
to the development and
progression of atherosclerosis.
• family history of PAD
• Diabetes is also a significant risk
factor for CTLI, as it damages the
blood vessels and nerves, leading to
poor wound healing and an
increased risk of infection.
• Hypertension and hyperlipidemia
increase the risk of atherosclerosis
and its complications.
• Genetics also play a role in the
development of CTLI, as some
individuals may have a genetic
predisposition to atherosclerosis.

6. Symptoms
and
Diagnosis

7. Symptoms
• The symptoms of CTLI are similar to those of PAD, but
they are more severe and persistent.
• The typical symptoms of CTLI include pain in the legs,
especially during walking or exercise, as well as skin
changes such as discoloration, hair loss, and ulcers.
• The pain is usually relieved by rest and worsens with
activity.
• As the disease progresses, the pain may occur at rest or
during the night, and the skin may become thin, shiny,
and cool to the touch.
• Advanced cases of CTLI can result in skin breakdown,
ulcers, and gangrene.

8. Diagnosis

9. • Angiography is an invasive test that uses
contrast dye and X-rays to visualize the
arteries in the lower extremities.
• Magnetic resonance angiography (MRA)
and computed tomography angiography
(CTA) are non-invasive tests that can also
be used to visualize the arteries.

10. Treatment Options
• The treatment of CTLI depends on the severity of the condition and
the patient's overall health.
• The treatment goals are to relieve symptoms, prevent complications,
and improve quality of life. The treatment options for CTLI include
lifestyle changes, medications, revascularization procedures, and
multidisciplinary care and rehabilitation.
• Lifestyle changes such as smoking cessation, increasing physical
activity, and maintaining a healthy diet are essential in the
management of CTLI.
• Smoking cessation is the most critical lifestyle change, as it can halt
the progression of atherosclerosis and reduce the risk of
complications.
• Physical activity can help improve blood flow to the lower extremities,
reduce the risk of cardiovascular disease, and improve overall health.
• A healthy diet can also help reduce the risk of atherosclerosis and its
complications.

11. • Medications such as antiplatelet agents and
vasodilators can improve blood flow to the
affected area.
• Antiplatelet agents such as aspirin, clopidogrel,
and ticagrelor are commonly used in the
treatment of CTLI to prevent blood clots from
forming and can reduce the risk of cardiovascular
events.
• Vasodilators, such as cilostazol and pentoxifylline,
can improve blood flow by relaxing the blood
vessels and reducing inflammation.
• Revascularization procedures aim to restore
blood flow to the affected area by bypassing or
dilating the narrowed or obstructed arteries.

12. Revascularization
• Angioplasty is a minimally invasive procedure
that uses a balloon catheter to dilate the
narrowed artery, improving blood flow.
• A stent may be placed to help keep the artery
open. Bypass surgery involves creating a new
pathway for blood flow by using an
autogenous vein graft or a synthetic graft.
• Multidisciplinary care teams consisting of
vascular surgeons, interventional radiologists,
podiatrists, wound care specialists, and
physical therapists can provide comprehensive
care to patients with CTLI.
• Rehabilitation programs can help improve the
patient function.