Critical limb ischemia, also known as chronic limb-threatening ischemia, is a clinical illness characterized by ischemic discomfort at rest and ischemic tissue, such as non-healing ulcers or gangrene, caused by peripheral arterial disease of the lower extremities. Critical limb ischemia (CLI) is a gradual process that occurs over time. With CLI, patients are at a substantially increased risk of limb amputation and cardiovascular problems.
ICD-10-CM already comprised codes for peripheral vascular disease of the extremities with rest distress, perforation, and gangrene. In light of this, it was decided that no additional ICD-10-CM coding for critical limb ischemia was required. Rather, the idea explicitly examined specific codes that define critical limb ischemia. Consequently, this entailed concentrating on the Tabular’s explanatory notes and the Index’s sections. New inclusion words are included in the coding for critical limb ischemia in the Tabular List within category I70, Atherosclerosis, effective with discharges on October 1, 2020, to identify the coding for critical limb ischemia. There are also new subentries in the Alphabetic Index that guide readers to category I70. Critical limb ischemia is classified as atherosclerosis of the extremities with rest discomfort without more information.
CLI is a long-term condition that causes significant pain in the feet or toes, even when at rest. Poor circulation can result in sores and lesions in the legs and feet that do not heal. CLI complications will result in amputation of the afflicted limb if left untreated.
Peripheral Artery Disease
- In peripheral artery disease, plaque accumulates in the arteries, narrowing or obstructing the vessel’s lumen over time.
- Blood flow across the artery is reduced or blocked, limiting sufficient oxygen from reaching the distal extremities.
- About 12% of individuals in the United States have clinically serious peripheral artery disease.
Critical Limb Ischemia
- Approximately 11% of those with peripheral artery disease may suffer critical limb ischemia.
- Critical limb ischemia affects roughly 1.3 percent of people in the United States.
- The limb is at risk with critical limb ischemia. The end-stage peripheral arterial disease of the lower extremities is critical limb ischemia.
Critical limb ischemia symptoms
Ischemic rest discomfort, extreme pain in the legs and feet while a person is not moving, or non-healing sores on the feet or legs, is the most common symptoms of critical limb ischemia. Other signs and symptoms include:
- Numbness or pain in the feet
- Legs or feet with a lustrous, smooth, and dry appearance.
- Toenail thickening is a condition in which the toenails get thicker.
- In the legs or feet, there is no weak pulse.
- Sores that won’t heal, skin infections, or ulcers that won’t heal
- Legs or feet with dry gangrene (dry, black skin).
Critical limb ischemia treatment
Critical limb ischemia is a life-threatening condition that needs immediate medical attention to restore blood flow to the afflicted region. The preservation of the limb is the top priority.
Endovascular therapy
In the treatment of CLI, minimally invasive endovascular therapy is frequently used. The Vascular Center offers a complete range of endovascular procedures. The suggested therapy is determined by the location and severity of the blockages. Most CLI patients have numerous artery blockages, including those below the knee. In general, access to the diseased section of the artery is gained by puncturing the groin under local anesthetic and inserting a catheter into the groin artery. Endovascular techniques for the treatment of CLI
Angioplasty: A small balloon is introduced into the groin through a puncture. The balloon is inflated with a saline solution to open the artery one or more times.
Cutting balloon: To dilate the diseased region, a balloon with micro-blades is employed to dilate the diseased region. The blades cut the plaque’s surface, lowering the force required to dilate the artery.
Cold balloon (CryoPlasty): Instead of saline, nitrous oxide inflates the cold balloon (CryoPlasty). The gas causes the plaque to freeze. The operation is gentler on the artery, the plaque’s development is slowed, and scar tissue is minimal.
Stents: Metal mesh tubes that provide scaffolding are left in place after balloon angioplasty has opened an artery.
Balloon-expanded stent: The stent is enlarged with the help of a balloon. These stents are more durable, although they are less flexible.
Compressed stents are given to the sick location and self-expand. When they are released, they grow. These stents have a greater range of motion.
Laser atherectomy: The tip of a laser probe destroys small plaque particles during laser atherectomy.
Directional atherectomy: Plaque is physically removed from the artery using a catheter with a spinning cutting blade, allowing the flow channel to open.
The recovery time for these treatments is generally one or two days, and the majority of them are performed as outpatient procedures. The control of atherosclerosis risk factors is part of the treatment (see reducing risk factors).
Surgical procedures
Additional surgical treatments or other follow-up therapy may be required to treat wounds or ulcers. Surgical surgery is frequently advised if endovascular therapy fails to resolve the arterial obstructions. This usually entails using a vein from the patient or a synthetic graft to bypass the sick portion. The length of stay in the hospital following a bypass surgery might range from a few days to more than a week. Surgery recovery might take many weeks.
