Vascular Ischemia of Toes - Causes, Stages, Diagnosis, and Treatment

What Is Vascular Ischemia?

Vascular ischemia is defined as inadequate blood supply to any part of the body. The cessation (termination) of the blood supply can be complete or partial. Any body part can be affected, and the harmful effects of vascular ischemia occur due to hypoxia (deprivation of oxygen to tissues), inadequate supply of nutrients, and inadequate clearance of metabolites (a product made or used when the body breaks down food, chemicals, or its tissue).

What Are the Risk Factors for Vascular Ischemia of Toes?

Risk factors for vascular ischemia include:

• Age.

• Obesity.

• Diabetes.

• Smoking and using tobacco products.

• Inactive lifestyle.

• High blood pressure (hypertension).

• High cholesterol (hyperlipidemia).

• Family history of cardiovascular disease.

• Chronic kidney disease.

What Are the Stages of Vascular Ischemia of Toes?

Vascular disease can cause damage to the vascular system. The vascular system is classified into two main groups - arteries and veins. The arteries supply oxygenated blood from the heart to the rest of the body, and the veins supply this blood back to the heart. The commonest and most important cause of ischemia is arterial blood supply blockage.

‘Vascular ischemia of toes’ can be classified as acute, chronic, or critical. Acute cases occur due to a sudden decrease in blood flow to the affected toe. It occurs when a part of plaque or blood clot breaks free and blocks a blood vessel. Chronic cases develop slowly as a result of the narrowing of blood vessels. Chronic cases can become critical if the narrowed blood vessels are completely blocked.

What Causes Vascular Ischemia of Toes?

Most critical cases of vascular ischemia are caused by peripheral artery disease (a condition in which narrowed blood vessels results in low blood supply to the limb). Atherosclerosis (which happens due to the buildup of plaque inside the arteries) is another cause of vascular ischemia. Other causes of vascular ischemia include:

• Embolism (a blood clot from one area travels to another area of the body and causes sudden blockage of blood flow to a particular organ).

• Trauma.

• Compartment syndrome occurs due to increased pressure inside the muscle compartment, which reduces the blood flow and leads to permanent muscle damage.

What Are the Signs and Symptoms of Vascular Ischemia of Toes?

The signs and symptoms of ischemia vary depending on how rapidly the blood flow is reduced and the site of the blockage. The common signs and symptoms of vascular ischemia include:

• The patient complains of cold feet and skin that is cold to the touch. It is seen in all stages of ischemia.

• Muscle cramps after physical activity.

• Toe discoloration (purplish or reddish).

• Numbness or tingling feeling in the legs or feet.

• Smooth, shiny, dry skin present over legs or feet.

• Thickening of toenails.

• Intermittent claudication: Repeated pain in the lower extremities, usually in the calves, develops during walking. Pain is relieved by 5 to 15 minutes of rest, after which the patient can walk the same distance.

• Pale feet when elevated.

• Diminished or lack of pulse in the legs and feet.

• Ischemic tissue damage: Ulcers that may be dry and localized or get infected, leading to a septic infection.

• In some cases, discharge from gangrene (tissue death due to lack of blood flow).

• Swelling of feet.

How Can One Diagnose Vascular Ischemia of Toes?

The vascular ischemia of toes can be diagnosed through history taking and physical examination. The different methods of diagnosis include:

• Physical Examination: The doctor will examine the feet for signs of poor circulation, such as pale or bluish skin, cold (to touch) lower extremities, and skin texture. Doctors also look for absent or diminished pulses in the leg.

• Ankle-brachial Index (ABI): It is one of the widely used parameters which compares the blood pressure in the ankle region to the blood pressure in the arm. Patients with claudication (pain in the legs while walking) typically have an ankle-brachial index of 0.5 to 0.8, while critical cases of vascular ischemia have a 0.4 or less ankle-brachial index.

• Doppler Ultrasound: It measures the direction and velocity of blood flowing through the vessels. This method uses sound waves to create an image of blood flow in the feet and legs.

• CT Angiography: CT angiography is an advanced X-ray procedure that generates three-dimensional images using a computer.

• MRA (Magnetic Resonance Angiography): This procedure uses radiofrequency waves in a strong magnetic field. With the help of a computer, it generates two or three-dimensional images of the affected blood vessels.

• Peripheral Angiogram or Extremity Angiography: Procedure of locating the narrowed or blocked areas of blood vessels with the help of contrast dye and X-rays.

How Can Vascular Ischemia of Toes Be Treated?

‘Vascular ischemia of toes’ should be treated as early as possible to avoid further complications. The main objective of treatment is restoring normal blood flow. The treatment methods include:

• Medications to control high blood pressure or high cholesterol.

• Medications to control atherosclerosis (hardening of the arterial walls due to the buildup of fat and cholesterol or plaque) or peripheral artery disease.

• Lifestyle changes to reduce obesity.

• Wound treatment in case of nonhealing conditions or infections.

Surgical treatment is required to remove the blockage and increase the diameter of blood vessels. The purpose of surgery is to improve the blood flow in the blood vessel. Surgical treatment includes:

• Angioplasty: A balloon-tipped catheter (thin tube) is inserted into the artery to open a blocked blood vessel and thereby improve the blood flow.

• Laser Atherectomy: This procedure uses a catheter that emits high-energy ultraviolet radiation to remove blood clots from the blood vessels.

• Directional Atherectomy: In this approach the blood clots are removed with a catheter with a rotating cutting blade at the tip.

• Peripheral Bypass Surgery: The procedure helps redirect the blood flow around a blocked artery through a synthetic graft (plastic tube) or a vein taken from the body.

• Endarterectomy: Procedure in which the artery is opened and the clots are removed.

• Amputation: All or part of the limb is removed in this procedure. It is performed as the last choice of treatment where the above strategies fail to restore the blood supply.

Conclusion:

Vascular ischemia is a serious medical condition requiring proper diagnosis and medical treatment at the right time. Otherwise, it can lead to serious life-threatening conditions. It is advised not to neglect any symptoms that indicate a blood vessel blockage. Even after successful medical treatment, it is important to maintain a healthy lifestyle to ensure the treatment’s benefits are not lost.