Chronic Limb-Threatening Ischemia

Published: June 2019
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  • Key Points
  • Recommendations
    • Definitions and nomenclature
    • Global epidemiology and risk factors for CLTI
    • Diagnosis and limb staging in CLTI
    • Medical management
    • The GLASS for CLTI
    • Strategies for EBR
    • Nonrevascularization treatments of the limb
    • Biologic and regenerative medicine approaches in CLTI
    • The role of minor and major amputations
    • Postprocedural care and surveillance after infrainguinal revascularization for CLTI
  • Tables
    • Wound grading in Wound, Ischemia, and foot Infection (WIfI) classification
    • Ischemia grading in Wound, Ischemia, and foot Infection (WIfI) classification
    • Foot infection grading in Wound, Ischemia, and foot Infection (WIfI) classification
    • Assignment of GLASS stage
    • Descriptive summary of GLASS stages of infrainguinal arterial disease
  • Algorithms
    • Flow diagram for the investigation of patients presenting with suspected CLTI
    • Suggested algorithm for anatomic imaging in patients with CLTI who are candidates for revascularization
    • PLAN framework of clinical decision-making in CLTI; infrainguinal disease
  • Figures
    • SVS WIfI Clinical Limb Stage
    • The benefit of performing re-vascularization in CLTI increases with degree of ischemia and with the severity of limb threat (WIfI stage)
    • Femoropopliteal (FP) disease grading in GLASS
    • Infrapopliteal (IP) disease grading in GLASS
    • Flow chart illustrating application of GLASS to stage infrainguinal disease pattern in CLTI
    • Inframalleolar (IM)/pedal disease descriptor in GLASS
    • Preferred initial revascularization strategy for infrainguinal disease in average-risk patients with suitable autologous vein conduit available for bypass
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The Society for Vascular Surgery (SVS) is a not-for-profit professional medical society, composed primarily of vascular surgeons, that seeks to advance excellence and innovation in vascular health through education, advocacy, research and public awareness. SVS is the national advocate for 5,400 specialty-trained vascular surgeons and other medical professionals who are dedicated to the prevention and cure of vascular disease.

Description

This pocket guide attempts to define principles of practice that should produce high-quality patient care. It is applicable to specialists, primary care, and providers at all levels. This pocket guide should not be considered exclusive of other methods of care reasonably directed at obtaining the same results. The ultimate judgment concerning the propriety of any course of conduct must be made by the clinician after consideration of each individual patient situation. Neither IGC, the medical associations, nor the authors endorse any product or service associated with the distributor of this clinical reference tool.

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