Management of Chronic Limb-Threatening Ischemia (Clti) With Severe Infrapopliteal Attenuation Through Margavarana Chikitsa: A Clinical Case Study

Background: Chronic Limb-Threatening Ischemia (CLTI) complicated by distal arterial hypoplasia and inadequate distal runoff presents a substantial barrier to conventional endovascular or surgical revascularization. When mechanical options fail, conservative management focused on microvascular pathways becomes crucial. Methods: A 36-year-old male presenting with severe bilateral intermittent claudication (Rutherford Category 3; pain-free walking distance of 50–100 m) and severely attenuated infra-popliteal vessels was admitted to Panchakarma at the National Institute of Ayurveda Hospital, Jaipur. He was managed with a structured 23-day protocol consisting of 5 days of Udwartana (Days 1–5) followed by 18 days of Patra Pinda Sweda (Days 6–23). Concurrently, a 16-day scheduled internal Kala Basti regimen (Days 1–16) using Anuvasana of Vrihat Saindhwadi Taila and a Niruha of Lekhaniya Mahakashaya Kwatha with Eranda-mooladi Kwatha was administered. This was accompanied by a localized 14-day Indrabasti Bahya Basti (Days 6–19) using Dashmoola Taila and succeeded by a 7-day Panchatikta Kshira Basti (Days 17–23) along with oral formulations. Results: The integrative protocol successfully bypassed the structural limitations of the narrowed vessels where mechanical Fogarty catheterization had previously failed. Objective staging showed an improvement from Rutherford Category 3 (severe claudication) to Category 1 (mild claudication), with pain-free walking distance increasing to over 400 meters, resulting in functional limb salvage. Conclusion: Sequential Ayurvedic interventions addressing Marga avarana provide an effective, non-invasive therapeutic pathway for functional collateral development and limb salvage in surgical "no-option" peripheral vascular diseases.