Confused between Critical Limb Ischemia vs. Peripheral Artery Disease? Know the difference here.
Critical Limb Ischemia (CLI) is considered a severe form of Peripheral Artery Disease (PAD) that leads to complete or partial blockage of the blood flow into the limbs. The build-up of fatty substances inside the artery walls leads to plaque formation, resulting in blockage of the blood flow. Patient experiences ischemic pain due to the formation of non-healing ulcers or gangrene.
CLI develops over several weeks to months and calls for medical emergencies. Critical Limb Ischemia (CLI) remains asymptomatic and are diagnosed suddenly. There can be complete loss of the affected limb.
Critical Limb Ischemia: Who is at Risk?
CLI affects the limbs due to blockage of the sufficient blood supply. Severe blockage in lower extremities occur that result in sharp resting pain in lower limbs. PAD is an umbrella term that represents all form of peripheral conditions. CLI represents a life-threatening condition that affects your limbs.
Individuals with PAD are at critical risk of developing CLI. Other risk factors include:
- An individual diagnosed with atherosclerosis and increasing age
- Diabetes
- Chronic Kidney Disease
- Hypertension
- Hyperlipidemia (high cholesterol)
- Substance abuse (alcohol and smoking)
Symptoms & Warning Signs of Critical Limb Ischemia
The most common symptoms associated with CLI include intense leg or foot pain. Some individuals do not experience any pain, and other symptoms might include:
- Cold hands, feet, or legs
- Numbness in your hand, feet or leg
- Occurrence of non-healing wounds and ulcers
- Skin discolouration or discharge
- Gangrene formation and tissue loss
Critical Limb Ischemia Criteria: Diagnosis & Tests
On suspicion of Critical Limb Ischemia Criteria, healthcare practitioners can recommend several tests individually or in combination. The aim is to determine the blood flow in an individual’s different limbs. The diagnostic test includes:
- Hemodynamic measurements: This involves non-invasive diagnostic methods like ankle-brachial index (ABI), which determines systolic blood pressure in the ankles, and toe pressure (TP), where toe pressure is determined.
- Imaging studies:
- Doppler ultrasound
- Computed Tomography Angiography (CTA)
- Magnetic Resonance Angiography (MRA)
The diagnosis of CLI at the early stage is crucial for adequate treatment of the patient.
Critical Limb Ischemia ICD-10 Codes
Currently, Critical Limb Ischemia ICD 10 codes are mainly classified under atherosclerosis of extremities, as it is often considered an extreme form of PDI. CLI ICD 10 is primarily coded under I70 (atherosclerosis).
Most common ICD-10 codes include:
- I70.22 – Atherosclerosis of native arteries of extremities with rest pain
- I70.23 – Atherosclerosis of native arteries of extremities with ulceration of the thigh
- I70.24 – Atherosclerosis of native arteries of extremities with ulceration of the calf
- I70.25 – Atherosclerosis of native arteries of extremities with ulceration of the ankle and foot
- I70.26 – Atherosclerosis of native arteries of extremities with gangrene
- I99.8 – Presence of 6 Ps: Pain, Pallor, Paralysis, Paresthesia, Pulselessness, Poikilothermic
Preventing Critical Lower Limb Ischemia ICD 10
Do you have PAD and worry about how to prevent CLI progression? Here is how CLI progression be prevented:
The prevention of CLI risk factors can be done by:
- Maintaining and achieving the optimal weight per individual’s age, sex and body type
- Practicing regular exercise like aerobics, strength training, flexibility, etc.
- Maintaining the cholesterol level and blood pressure within a healthy range
- Managing other chronic conditions like diabetes
- Reduction of stress and eating healthy
Treatment for Critical Limb Ischemia
CLI treatment depends on the severity of the condition. This involves:
- Medication Management: Medication recommended includes antiplatelet and anticoagulant that reduce clots, reduce blood pressure and lower cholesterol. Other medication includes pain management and wound care.
- Endovascular Treatment: Angioplasty, Stenting, and Atherectomy
- Surgery: Repair or replacement of damaged arteries using their own vein or a synthetic replacement.
With medication and endovascular treatment risk of disease recurrence remains. Surgery increases the risk of vascular compromise with an increase in the significant rate of amputation.
Importance of Timely Treatment and Limb Salvage
- Prevention of amputation
- Improving quality of life
- Long-term outcomes with early intervention
Emerging Therapeutic Care for CLI
Stem cell therapy (SCT) is an advanced form of regenerative medicine that addresses the root cause of the disease. SCT for CLI is an advanced option that promotes angiogenesis, neovascularization, development of collateral arteries, etc.
SCT involves the introduction of stem cells in patients with CLI, where the degenerated or damaged cells regenerate themselves. The primary function of SCT in CLI includes:
- Vasculogenesis and Angiogenesis: Stem cells enable the formation of new blood vessels that allow adequate flow of blood into the limbs. Stem cells releases various growth factors (cytokines & chemokines) that promotes regeneration of new cells and supports new blood vessel formation.
- Arteriogenesis: This involves collateral growth where pre-existing arterioles get transformed into functional arteries.
- Wound Healing: The improved blood flow and regeneration of the new cells enable wound healing and cure ulcers or gangrene formation.
Route of Administration
SCT have various route of administrations. This includes:
Intramuscular Route:
- Creates a paracrine cellular depot within ischemic muscle tissue
- Promotes angiogenesis and neovascularization by the release of growth factors
- Significant improvement in tissue repair, oxygenation and ulcer healing
Intra-Arterial Route:
- Delivers stem cells directly to the site of arterial circulation
- Success remains strictly on cell homing to ischemic tissue
- Improves pain; less effective compared with the intramuscular route of administration
Combination Route:
- Better outcome compared with single-mode
- Enhanced oxygenation, ulcer healing and sustained angiogenic activity
Recommendations
- Consult experienced healthcare practitioners and clinics providing stem cell therapy.
- The quality of the stem cells used for therapy must be of superior quality
- Discuss straightforward expectations for pre- and post-treatment outcomes
- Discuss the cost incurred for the treatment
Advancells, Noida, is one of the leading research laboratories of stem cells that follows strict guidelines to culture and maintain the superior quality of the stem cells. The cells undergo a stringent screening process for presence of any infection or mutagenesis.
Adverse Effect of SCT
The majority of the patients show improved rest pain, oxygen pressure, and pain-free walking after six months of treatment. Some side effect includes:
- High mortality among patients who underwent autologous stem cell implantation for CLI
- Patients implanted with bone marrow-mononuclear cells demonstrated a high mortality rate.
*NOTE: Similar risks remains on implementation of traditional surgical procedures.
Patient Success Stories
Conclusion
CLI is a life-threatening condition with higher mortality rate. Individuals experiencing any of the symptoms must consultation healthcare specialist. Healthcare practitioner recommending regenerative medicine must provide clear overview about the treatment process. Patients must discuss about treatment procedure, expected outcomes, cost incurred, and possible side effects.
It’s always wiser to make informed decisions.
FAQ’s
Q- Are Critical Limb Ischemia (CLI) and peripheral artery disease (PAD) the same?
No, CLI and PAD are not same. CLI is most severe forms of PAD associated with pain in limbs. It is characterized with resting pain in limbs, ulcers or gangrene.
Q- What are the significant symptoms of CLI?
The primary symptoms of CLI include resting pain, untreatable ulcers, gangrene (death of tissues), etc. The blood flow in the lower limb is compromised.
Q- What are the best treatment options for CLI?
The best treatment for CLI includes medications, surgery, (revascularization, and angiography). Advanced treatment includes regenerative medicines (stem cell therapy and exosome therapy).
Q- How can I reduce the risk of CLI if I have PAD?
Maintain cholesterol level, hypertension and diabetes. Maintain an ideal weight, follow balanced diet, and regular exercise.
Recent Comments