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Vascular Disease

Advanced Care for Critical Limb Ischemia (CLI)

The highly trained vascular specialists at University Hospitals Harrington Heart & Vascular Institute have decades of experience and the expertise needed to diagnose and treat patients with even the most complex cases of critical limb ischemia, or CLI.

Our team of CLI specialists are internationally recognized for their expertise – writing the guidelines for improved diagnostic and treatment protocols and teaching vascular specialists from across the country on techniques to better manage patients with critical limb ischemia. In addition to specific CLI care, our specialized team is developing an amputation prevention board to evaluate patients at extreme risk of losing a limb.

What is Critical Limb Ischemia?

CLI is a severe blockage in the arteries of the lower extremities. It is an advanced stage of peripheral arterial disease that significantly reduces blood flow and leads to severe pain in the feet or toes, even when there is no movement.

While severe pain in the feet and toes is the main symptom, patients with this condition may also experience other critical limb ischemia symptoms, including non-healing wounds or sores on their feet or legs, pain or numbness in their feet, thickening of toenails, and a lack of a pulse in the legs or feet.

Team Approach Improves Outcomes of CLI Treatment

We work together as a multidisciplinary team of UH specialists, including:

  • Interventional cardiologists
  • Vascular surgeons
  • Vascular specialists
  • Wound care specialists
  • Podiatrists

Our advanced treatments re-establish blood flow and improve circulation to reduce ischemia symptoms such as ulcers and preserve limb function.

Personalized Critical Limb Ischemia Treatments Preserve Limb Function

The main goal of critical limb ischemia treatment is to preserve the limb by re-establishing blood flow to the affected area. At University Hospitals, we provide innovations in treatment through research and clinical trials that are only available at a select few vascular centers across the country.

Some of the most effective treatment options for this condition are minimally invasive endovascular therapies such as:

  • Atherectomy: In a laser atherectomy, the tip of a laser probe vaporizes small pieces of plaque. A directional atherectomy involves using a catheter with a rotating blade to remove plaque.
  • Angioplasty: An angioplasty involves inserting a tiny balloon through a puncture in the groin. A saline solution inflates the balloon a few more times so that the artery can be opened.
  • Stents: After an artery has been opened through angioplasty, metal mesh tubes that provide support are left in place.
  • Revascularization: Blood flow is restored by opening the veins through stents, balloons or bypass around the blocked arteries in the leg.
  • Venous arterialization: For end-stage patients when more conventional treatments are no longer an option, our team provides an innovative approach through a novel clinical trial. We connect the diseased vein with an artery, using a percutaneous approach – through the skin – to reestablish blood flow.

Fortunately, recovering from these endovascular therapies only takes a few days. If these treatments do not resolve blood flow significantly enough, a surgical procedure known as a bypass graft may be recommended. During a bypass graft, our surgical specialists use an artificial tube or vein from your body to route blood flow around your damaged artery to bring improved blood flow to the affected area. The purpose of a bypass graft is to bypass the area of constricted blood flow.

Limb Salvage and Amputation Prevention

As one of a select number of centers in the U.S., UH Harrington Heart & Vascular Institute offers a limb salvage program that is transforming the standard of care for no-option critical limb ischemia patients at risk of amputation. Vascular specialists at UH are national principal investigators for multiple clinical trials aimed at reducing leg amputations, giving patients unparalleled access to novel therapies to prevent lower extremity limb loss.

Advanced Limb Salvage Procedures and Clinical Trials

  • LimFlow Percutaneous Deep Vein Arterialization (pDVA) System: This breakthrough clinical trial employs a novel proprietary technique to provide endovascular venous arterialization. The goal is to redirect blood from restricted arteries into the lower leg veins in order to resupply oxygen to the surrounding tissue. Outcomes from the procedure include wound healing, limb salvage, and remarkable changes in the vasculature of the foot. UH Cleveland Medical Center is one of five centers nationally and the only center in Ohio offering LimFlow to end-stage CLI patients.
  • Biologic therapy: Used in conjunction with revascularization, biological therapy is injected into the foot to observe wound healing in a more timely fashion. The biologic stimulates and directs naturally occurring angiogenic (formation of new blood vessels) factors in the body to the site of injury, with the hope that new small blood vessels will build to improve circulation.
  • “Chocolate” drug-coated balloon catheter: The “Chocolate Touch” clinical trial evaluates whether this second-generation device is superior to the older Lutonix model. With this trial, investigators are hoping for patients to achieve unobstructed blood flow without stenting.
  • Radial to peripheral (R2P) program: R2P allows complex procedures in the leg to be performed via the radial approach (through the wrist), widely used for cardiac procedures. The last five to 10 years have shown when patients are treated from the wrist, it is less risky, associated with less bleeding, and patient satisfaction and quality of the procedure are higher than if done through the groin.

Vascular Specialists for Expert Critical Limb Ischemia Risk Factor Management

Our UH vascular disease specialists are skilled in the medical aspects of vascular disease treatment. They help our patients by closely monitoring and better managing diseases or conditions that affect vascular health. By controlling diabetes, cholesterol and hypertension issues, we can help keep these conditions and vascular issues from escalating. UH can also help reduce your risk of CLI and other vascular conditions through our dedicated smoking cessation program.

The risk factors for CLI are identical to those for a condition called atherosclerosis, which is the hardening and narrowing of the arteries as a result of the buildup of plaque. It is important to understand your personal risk factors, including:

Our team at University Hospitals can help you understand how even small lifestyle changes can significantly impact your risk of artery diseases, including critical limb ischemia.

We work with our patients to help them understand how to help prevent hardening or narrowing of the arteries. Adhering to a diet that is low in saturated fats, engaging in physical activity for at least 30 minutes a day, quitting smoking, and taking medications to reduce cholesterol and blood pressure are several examples of lifestyle changes that can reduce CLI risk. Our team of vascular specialists is available at a range of convenient locations across Northeast Ohio to help you learn how to improve your vascular health.