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Published on: September 22, 2020
Critical Limb Ischemia: An Expert Statement
Mehdi H Shishehbor1, Christopher J White2, Bruce H Gray3
1Cleveland Clinic, Cleveland, Ohio.
Insights
Critical limb ischemia (CLI), a severe form of peripheral artery disease, leads to high mortality and amputation rates. Despite advances, CLI remains undertreated, with significant disparities in care access and outcomes.
Area of Science:
- Vascular Surgery
- Cardiology
- Peripheral Artery Disease Management
Background:
- Critical limb ischemia (CLI) is the most severe stage of peripheral artery disease (PAD).
- CLI significantly increases morbidity, mortality, and healthcare costs.
- Associated consequences include amputation and psychosocial distress, with heightened risk of contralateral limb loss post-amputation.
Purpose of the Study:
- To provide a comprehensive overview of critical limb ischemia (CLI).
- To summarize diagnostic assessments, treatment options, and emerging therapies for CLI.
- To highlight disparities and challenges in current CLI management.
Main Methods:
- Literature review and synthesis of current knowledge on CLI.
- Analysis of diagnostic strategies for CLI.
- Evaluation of endovascular, open surgical, and regenerative treatment modalities.
Main Results:
- CLI management involves complex diagnostic and therapeutic considerations.
- Significant disparities exist in revascularization and amputation rates based on race, socioeconomic status, and geography.
- Challenges in reimbursement and interdisciplinary care coordination persist.
Conclusions:
- Despite technological advancements, CLI remains undertreated, with persistent care gaps.
- A multidisciplinary approach is crucial for optimizing CLI patient outcomes.
- Addressing socioeconomic and geographic disparities is essential for equitable CLI care.
Abstract:
Critical limb ischemia (CLI), the most advanced form of peripheral artery disease, is associated with significant morbidity, mortality, and health care resource utilization. It is also associated with physical, as well as psychosocial, consequences such as amputation and depression. Importantly, after a major amputation, patients are at heightened risk of amputation on the contralateral leg. However, despite the technological advances to manage CLI with minimally invasive technologies, this condition often remains untreated, with significant disparities in revascularization and amputation rates according to race, socioeconomic status, and geographic region. Care remains disparate across medical specialties in this rapidly evolving field. Many challenges persist, including appropriate reimbursement for treating complex patients with difficult anatomy. This paper provides a comprehensive summary that includes diagnostic assessment and analysis, endovascular versus open surgical treatment, regenerative and adjunctive therapies, and other important aspects of CLI.
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