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Contemporary Chronic Limb-Threatening Ischemia Care in the United States-Part 1: A Path Toward Multispecialty
Eric A Secemsky1, Ehrin J Armstrong2, Venita Chandra3
1Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Insights
Optimizing care for chronic limb-threatening ischemia (CLTI) requires multidisciplinary teams. Integrating vascular medicine, podiatry, and other specialists improves patient outcomes and reduces amputations.
Area of Science:
- Vascular Medicine
- Interdisciplinary Care
Background:
- Chronic limb-threatening ischemia (CLTI) care is complex and requires collaboration.
- A rise in major limb amputations necessitates improved CLTI management strategies.
Purpose of the Study:
- To discuss the current state of CLTI care in the U.S.
- Identify challenges in CLTI care delivery and access.
- Explore multidisciplinary approaches to enhance CLTI outcomes.
Main Methods:
- Convened a 2024 Vascular Leaders Forum.
- Included multispecialty representatives: vascular surgery, interventional cardiology, interventional radiology, vascular medicine, podiatry, regulators, industry, and patient advocates.
- Focused on challenges and collaborative solutions for CLTI care.
Main Results:
- Recommended integrated CLTI care teams beyond traditional surgical specialties.
- Advocated for inclusion of vascular medicine, podiatry, wound care, diabetology, and dietetics.
- Emphasized the need for care spanning tertiary, community, outpatient, and primary settings.
Conclusions:
- Enhanced collaboration across diverse specialties is crucial for effective CLTI management.
- Expanding CLTI care teams to include non-surgical specialists can improve patient outcomes.
- A coordinated, multisite approach is essential to meet the growing demand for CLTI revascularization.
Abstract:
Care for patients with chronic limb-threatening ischemia (CLTI) is complex, and it is most effective when conducted with collaboration across multiple specialties. A recent upward trend in major limb amputation among patients with CLTI warrants a renewed effort to optimize care for this multifaceted condition. The Vascular InterVentional Advances (VIVA) Foundation, a not-for-profit 501(c)(3) organization, convened a Vascular Leaders Forum in 2024 to initiate an open, multispecialty discussion about the state of CLTI care in the United States and current challenges around delivery and access to such care. The forum comprised representatives from vascular surgery, interventional cardiology, interventional radiology, vascular medicine, podiatry, regulators, medical device manufacturers, patient advocacy, and the CLTI and CLTI caregiver population. This article explores the central themes of challenges in CLTI care and ways in which collaboration across specialties and care settings could improve CLTI outcomes. In summary, it was recommended that integrated CLTI care teams extend beyond vascular surgery, interventional cardiology, and interventional radiology to include vascular medicine, podiatry, wound care, diabetology, and dietetics. Meeting the increasing demand for CLTI revascularization will require these teams to span tertiary care hospitals, community hospitals, outpatient revascularization clinics, and primary care settings.
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