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Digital Subtraction Angiography Prior to an Amputation for Critical Limb Ischemia (CLI): An Expert Recommendation
Jihad A Mustapha1, Fadi A Saab1, Brad J Martinsen2
1Advanced Cardiac & Vascular Centers for Amputation Prevention, Grand Rapids, MI, USA.
Insights
Optimal treatment for critical limb ischemia (CLI) remains debated, leading to inconsistent care. Expert recommendations now emphasize interdisciplinary teams and advanced imaging, like superselective digital subtraction angiography (DSA), to improve limb salvage rates.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Optimal treatment for critical limb ischemia (CLI) is debated despite recent peripheral artery disease (PAD) guidelines.
- Inconsistent care for CLI patients often results in amputation before essential consultations and imaging.
- High-quality imaging is crucial for managing below-the-knee CLI.
Purpose of the Study:
- To provide an interdisciplinary expert recommendation for optimizing CLI treatment.
- To emphasize the importance of comprehensive imaging assessment in CLI management.
- To advocate for superselective digital subtraction angiography (DSA) in indicated CLI patients.
Main Methods:
- Development of an interdisciplinary expert consensus.
- Formulation of a recommended imaging algorithm for CLI patients.
- Focus on superselective digital subtraction angiography (DSA) including ankle and foot.
Main Results:
- Establishment of expert recommendations for CLI care.
- Inclusion of ankle and foot in DSA for below-the-knee CLI.
- A proposed imaging algorithm to guide clinical decisions.
Conclusions:
- Superselective DSA including the ankle and foot is recommended for properly indicated CLI patients.
- Interdisciplinary team consultation and comprehensive imaging are critical for limb salvage.
- The proposed algorithm aims to standardize and improve CLI patient care.
Abstract:
Despite recent guideline updates on peripheral artery disease (PAD) and critical limb ischemia (CLI) treatment, the optimal treatment for CLI is still being debated. As a result, care is inconsistent, with many CLI patients undergoing an amputation prior to what many consider to be mandatory: consultation with an interdisciplinary specialty care team and a comprehensive imaging assessment. More importantly, quality imaging is critical in CLI patients with below-the-knee disease. Therefore, the CLI Global Society has put forth an interdisciplinary expert recommendation for superselective digital subtraction angiography (DSA) that includes the ankle and foot in properly indicated CLI patients to optimize limb salvage. A recommended imaging algorithm for CLI patients is included.