Which symptom is most commonly associated with critical limb ischemia?

Severe pain in the legs and feet at rest is the symptom most commonly associated with critical limb ischemia (CLI). This condition arises due to significantly reduced blood flow to the lower extremities, often as a result of atherosclerosis. The pain, known as rest pain, typically occurs when the patient is at rest and may be aggravated by leg elevation or relieved by hanging the legs down. This is a key indicator of advanced ischemic disease and signifies that the limbs are not receiving adequate oxygenated blood to meet metabolic demands.

In contrast, increased temperature in the lower leg and foot is typically not seen in CLI; often, the affected limbs might actually feel cooler due to reduced blood flow. Likewise, bounding lower extremity peripheral pulses are not characteristic of CLI; in fact, claudication and eventual critical limb ischemia often present with diminished or absent pulses. Flaking skin on the legs with brownish discoloration can be indicative of venous insufficiency or chronic venous stasis, rather than critical limb ischemia, which primarily presents with pain and other features related to arterial occlusion.