Chronic Limb-Threatening Ischemia and the Need for Revascularization

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Critical Care Medicine

Background:

• Critical limb-threatening ischemia (CLTI) is an increasing vascular condition associated with high amputation and mortality rates.
• Optimal management strategies for CLTI remain challenging, with ongoing debate regarding surgical versus endovascular interventions.
• Evidence-based revascularization (EBR) aims to guide appropriate treatment selection for CLTI patients.

Purpose of the Study:

• To provide an overview of contemporary CLTI management.
• To emphasize the role of evidence-based revascularization (EBR) in optimizing treatment decisions.
• To highlight the importance of surgeon experience and patient risk stratification.

Main Methods:

• Comprehensive literature search of MEDLINE, Embase, and Scopus (1995-2022).
• Review of Global and ESVS Guidelines for CLTI management.
• Narrative synthesis of high-quality selected articles.

Main Results:

• Global Vascular Guidelines promote standardized CLTI classification and management through EBR.
• Patient suitability for revascularization requires risk stratification considering clinical and non-clinical factors.
• The BEST-CLI trial demonstrated autologous vein bypass superiority over endovascular therapy for CLTI, though 'no-option' patients remain a challenge.

Conclusions:

• Surgeon experience and skill are crucial for successful CLTI treatment within a multidisciplinary framework.
• The BEST-CLI trial indicates superior outcomes with open surgical peripheral vascular surgery compared to endovascular approaches for CLTI.
• Individualized risk assessment and evidence-based revascularization are key to improving CLTI patient care.