PRE-oPerative Assessment for Patients with Chronic Limb ThReatening IschEmia (PREPARE): A Multinational Delphi...

Area of Science:

• Vascular Surgery
• Patient Management
• Clinical Consensus

Background:

• Chronic limb-threatening ischemia (CLTI) poses diagnostic and management challenges.
• A lack of standardized preoperative assessment and optimization frameworks exists for CLTI patients.
• This study aimed to establish expert consensus on perioperative care for CLTI.

Purpose of the Study:

• To develop a contemporary consensus among vascular specialists on the perioperative care of CLTI patients.
• To address challenges in diagnosis and management of CLTI.
• To create standardized frameworks for preoperative assessment and optimization.

Main Methods:

• Modified Delphi methodology with 42 vascular surgeons from UK, Ireland, Australia, and New Zealand.
• Exploration of four domains: service availability, preoperative assessment, perioperative optimization, and multidisciplinary teams (MDTs).
• Consensus defined as ≥70% agreement.

Main Results:

• 59 consensus statements were established, including rapid access clinics and anemia management.
• Unanimous agreement on clear referral pathways and strong support for MDTs in complex cases.
• Significant uncertainty regarding risk prediction models (53% agreement); 81% agreed investigations changing intervention type should precede surgery.

Conclusions:

• CLTI management requires a multifaceted, interdisciplinary approach.
• Recommendations include improved primary care, selective preoperative investigations, and emphasis on interdisciplinary care.
• Ongoing uncertainties in risk prediction necessitate further research to validate tools and practices for improved patient outcomes.