Chronic limb ischemia occurs when the arteries that supply blood to the lower limbs become narrowed or blocked due to the buildup of fatty plaques (atherosclerosis). As a result, the muscles and tissues do not receive enough oxygen. The most common symptoms include pain while walking that improves with rest (intermittent claudication), a sensation of coldness in the feet, non-healing wounds, and, in severe cases, the risk of gangrene..

General Measures and Lifestyle Changes

Treatment begins with measures aimed at improving circulation and slowing disease progression:

• Smoking cessation: Tobacco use is the main risk factor.
• Supervised exercise: Regular walking in structured programs helps muscles use oxygen more efficiently and improves pain-free walking distance.
• Healthy diet and control of cholesterol, blood glucose, and blood pressure.

Medical Treatment

Medications are used to reduce complications and relieve symptoms:

• Antiplatelet agents (such as aspirin or clopidogrel) to prevent blood clot formation.
• Statins to control cholesterol levels and stabilize arterial plaques.
• In some cases, drugs that improve blood flow to alleviate walking-related pain.

Revascularization Treatments

When symptoms are severely limiting or there is a risk of limb loss, procedures to restore blood flow are required:

• Angioplasty with or without stenting: A catheter is used to dilate the blocked artery (Fig. 1). If this is not sufficient to keep the vessel open, a small metal mesh (stent) is placed to maintain patency.

Tratamientos de revascularizacion

Fig.1. A) Balloon catheter angioplasty (solid white arrows) of an occluded distal leg vessel.
B) Final result showing vessel reopening (empty white arrows).

• Bypass surgery: A graft (either the patient’s own vein or a synthetic conduit) is used to divert blood flow around the obstruction (Fig. 2)

Cirugia de bypass

Fig. 2: Distal bypass at the ankle level using the patient’s own saphenous vein (white arrows).

Conclusion

Currently, the treatment of chronic limb ischemia combines lifestyle modifications, pharmacological therapy, and, when necessary, revascularization techniques. Early diagnosis and prevention are essential to avoid serious complications such as amputation. Walking regularly, maintaining a healthy diet, and quitting smoking are just as important as medical or surgical interventions.