Current opinions about the definition of critical limb ischemia: A debate still open after three decades

Area of Science:

• Vascular Medicine
• Peripheral Arterial Disease Research
• Clinical Definitions and Guidelines

Background:

• Critical limb ischemia (CLI) represents the most advanced stage of peripheral arterial disease.
• CLI is characterized by rest pain, skin ulceration, or gangrene, associated with high rates of amputation and mortality.
• Despite over 30 years since its initial definition, a consensus on the precise definition of CLI remains elusive.

Purpose of the Study:

• To analyze the evolution of the definition of Critical Limb Ischemia (CLI).
• To clarify the changes in hemodynamic parameters used to define critical limb perfusion.
• To understand the conceptual shifts leading to terms like "limb-threatening ischemia".

Main Methods:

• Systematic review of guideline documents defining CLI in peripheral arterial disease.
• Analysis of historical and current definitions of CLI.
• Examination of changes in hemodynamic parameters used in CLI diagnosis.

Main Results:

• The definition of CLI has evolved significantly over three decades.
• Hemodynamic parameters used to define critical limb perfusion have changed, leading to confusion.
• Recent guidelines increasingly use the term "limb-threatening ischemia" over CLI.

Conclusions:

• Understanding the historical evolution of CLI definitions is crucial.
• The shift towards "limb-threatening ischemia" reflects ongoing refinement in defining severe limb perfusion deficits.
• Clarifying definitional changes aids in interpreting future trends in CLI management and research.