Clinical Decision-Making for Patients with Chronic Limb-Threatening Ischemia

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Endovascular Therapy

Background:

• Chronic limb-threatening ischemia (CLTI) presents complex treatment challenges.
• Patients often have comorbidities, increasing procedural risks and shortening life expectancy.
• Prompt revascularization, infection control, and surveillance are key management components.

Purpose of the Study:

• To provide an update on the diagnosis and management of CLTI.
• To review patient- and lesion-specific factors influencing treatment decisions between open surgery (OS) and endovascular therapy (EVT).
• To contrast common OS and EVT techniques and suggest a follow-up algorithm.

Main Methods:

• Review of randomized trials comparing OS and EVT for CLTI.
• Analysis of patient-specific and lesion-specific characteristics.
• Comparison of prevalent OS and EVT techniques.
• Development of a suggested follow-up algorithm.

Main Results:

• Both open surgery and endovascular therapy are viable treatment options for CLTI.
• Treatment choice depends on individual patient and lesion characteristics.
• Randomized trials support the efficacy of both OS and EVT.

Conclusions:

• Optimal CLTI treatment is individualized, balancing risks and benefits of OS versus EVT.
• Careful patient and lesion assessment is crucial for selecting the most appropriate revascularization strategy.
• A structured follow-up plan is essential for long-term CLTI management.