Critical limb ischaemia: a case against Consensus II

Area of Science:

• Vascular Surgery
• Clinical Trials
• Diagnostic Criteria

Background:

• Critical limb ischaemia (CLI) is a severe condition often leading to limb loss.
• Previous consensus documents (1989, 1991) provided definitions and management guidelines for CLI.
• The existing definition of CLI may be inaccurate and hinder effective treatment selection.

Purpose of the Study:

• To propose an amendment to the diagnostic criteria for critical limb ischaemia.
• To re-evaluate ankle and toe pressure thresholds used in clinical trials for CLI.
• To advocate for the inclusion of Doppler index and transcutaneous oxygen pressure (tcPO2) in CLI diagnosis.

Main Methods:

• Analysis of data from 140 patients with severe limb ischaemia from the PARTNER Group studies.
• Evaluation of existing ankle pressure and big toe pressure recommendations.
• Consideration of Doppler index and tcPO2 as supplementary diagnostic parameters.

Main Results:

• Evidence suggests current ankle pressure thresholds (< or = 50 mmHg) and big toe pressure thresholds (< or = 30 mmHg) for CLI diagnosis are too restrictive.
• The proposed revised thresholds are ankle pressure >50 mmHg and big toe pressure >30 mmHg.
• The current definition may exclude patients who would benefit from drug treatment or other interventions.

Conclusions:

• The definition of critical limb ischaemia requires amendment to accurately identify patients for clinical trials and treatment.
• Revised pressure thresholds and inclusion of Doppler index and tcPO2 are recommended for improved CLI diagnosis.
• Prioritizing these amendments is crucial to ensure appropriate patient selection for potentially life-saving interventions.