Chronic Limb-Threatening Ischemia (CLTI)

Chronic limb-threatening ischemia (CLTI) is the most severe form of peripheral artery disease, characterized by severely reduced blood flow to the legs and feet. Previously known as critical limb ischemia, CLTI represents an advanced stage where inadequate circulation causes chronic pain, wounds that won’t heal, and tissue death. Without prompt treatment, CLTI frequently leads to limb amputation.

CLTI typically develops when atherosclerosis—the buildup of plaque in arteries—becomes severe enough to critically restrict blood flow. The condition causes persistent ischemic rest pain (pain even when not walking), non-healing ulcers or wounds on the feet or legs, and gangrene. These symptoms indicate that tissues are not receiving the oxygen and nutrients necessary for survival.

Patients with CLTI face an urgent medical situation. Studies show that without revascularization treatment, approximately 40% of CLTI patients will require major amputation within one year. Risk factors mirror those for PAD but are often more severe and include diabetes, smoking, advanced age, kidney disease requiring dialysis, and long-standing peripheral artery disease. The condition disproportionately affects patients with diabetes due to the combination of arterial disease and neuropathy that can mask warning symptoms.

Treatment Options

At Western Surgical Group, we are Northern Nevada’s leaders in limb salvage, having established comprehensive limb salvage programs in the community and at local hospitals. Our vascular surgeons are experts in both endovascular and open surgical techniques designed to restore blood flow and save limbs.

Treatment for CLTI is aggressive and aims to restore adequate blood flow as quickly as possible. Our approach includes:

  • Advanced Endovascular Interventions: Minimally invasive procedures including angioplasty, stenting, and atherectomy to open severely blocked arteries, often extending into small vessels below the knee
  • Surgical Bypass: Open surgery creating alternate pathways for blood flow around blocked arteries, using your own vein when possible for best long-term results
  • Hybrid Procedures: Combining endovascular and open surgical techniques to address complex, multi-level arterial disease
  • Comprehensive Wound Care: Coordination with wound care specialists to promote healing once blood flow is restored

Our multidisciplinary approach coordinates care with primary care providers, endocrinologists for diabetes management, nephrologists for dialysis patients, infectious disease specialists when needed, and wound care teams. Starting Fall 2025, we will offer outpatient procedures at Galena Surgical Center for appropriate cases, expediting care and improving access to limb-saving treatment.

Divisions Involved in Your Care

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Procedures We Use

Frequently Asked Questions

CLTI is the most advanced stage of peripheral artery disease (PAD). While PAD may cause leg pain when walking, CLTI causes severe symptoms even at rest including persistent pain, non-healing wounds, and tissue death. CLTI is a medical emergency requiring urgent treatment to save the limb, whereas earlier stages of PAD can often be managed with lifestyle changes and medications.

Key warning signs include severe pain in the feet or toes at rest, especially at night or when legs are elevated; wounds, sores, or ulcers on feet or legs that don't heal within several weeks; blackened or gangrenous tissue on toes or feet; severe coldness or numbness in the affected limb; and shiny, discolored skin. If you experience any of these symptoms, seek immediate evaluation from a vascular surgeon.

Yes, with prompt and expert treatment, many limbs can be saved. Western Surgical Group's limb salvage program focuses specifically on restoring blood flow to preserve limb function. Success rates depend on several factors including the extent of arterial disease, presence of infection, overall health, and how quickly treatment begins. Our multidisciplinary approach and advanced surgical techniques have helped many patients avoid amputation.

Wound healing time varies based on wound severity, infection presence, nutritional status, and diabetes control. Once blood flow is restored, most wounds begin showing improvement within 2-4 weeks. Complete healing may take several months and requires ongoing wound care, pressure offloading, and management of underlying conditions. Your care team will monitor healing progress closely and adjust treatment as needed.

Recovery involves both healing from the revascularization procedure and ongoing management of the underlying condition. Hospital stays range from several days to a week or more depending on the procedure and complications. Physical therapy may be needed to regain strength and mobility. Long-term success requires strict adherence to medications, wound care protocols, diabetes management, smoking cessation, and regular follow-up appointments.

Some patients may require additional procedures to maintain blood flow over time. Regular surveillance with ultrasound or other imaging helps detect problems early before they become critical. Your vascular surgeon will establish a monitoring schedule tailored to your situation. Ongoing care also includes managing risk factors to prevent disease progression in other arteries and maintaining the revascularization site.