Gangrene and Critical Limb Ischemia

Laura Shin, D.P.M., Ph.D., David Armstrong, D.P.M., M.D., Ph.D., Lee J. Sanders, D.P.M.


  • Critical Limb Ischemia (CLI) of a limb is defined as persistent and severe pain in the foot, at rest, preventing sleep, and requiring repeated analgesia. Symptom duration >4 weeks, superficial skin necrosis of the foot or digital gangrene are required to make the diagnosis. Ankle systolic blood pressure < 40mmHg in the presence of rest pain, < 60mmHg in the presence of tissue necrosis.[16]
  • Earlier definitions of CLI excluded patients with diabetes.[16]
  • WIfI: Risk stratification based on three major factors that impact amputation risk and clinical management: Wound, Ischemia, and foot Infection. Refocuses approach to the patient with diabetes who has a threatened limb and a component of chronic ischemia according to disease severity rather than arterial lesion characteristics. Not intended for application to patients with acute limb ischemia, emboli, trauma or non-atherosclerotic disease.[2]
  • Gangrene is necrosis of tissue associated with ischemia (dry gangrene) or infection (wet gangrene).
  • Gas gangrene is a type of wet gangrene caused by infection with anaerobic bacteria (Clostridium) especially C. perfringens.
  • Acute Limb Ischemia (ALI) is defined as a sudden decrease in limb perfusion that threatens the viability of a limb, is associated with high rates of morbidity and mortality, and requires immediate vascular surgical evaluation and intervention.

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Last updated: July 7, 2020