How critical is chronic critical leg ischaemia?

Area of Science:

• Vascular Surgery
• Clinical Assessment
• Haemodynamics

Background:

• The term "critical" in critical leg ischaemia (CLI) signifies a turning point with unpredictable outcomes.
• Existing classifications, like the Fontaine scale, do not fully capture the prognostic uncertainty of CLI.
• The addition of ankle systolic pressure has not significantly improved the predictive accuracy of CLI definitions.

Purpose of the Study:

• To evaluate the adequacy of current definitions for critical leg ischaemia (CLI).
• To determine the predictability of CLI outcomes based on existing classifications.
• To propose improvements for CLI assessment in clinical and scientific contexts.

Main Methods:

• Review of the definition of "critical" in relation to ischaemia.
• Analysis of the limitations of the Fontaine classification (grades III and IV) for CLI.
• Evaluation of the impact of ankle systolic pressure measurements on CLI definition.

Main Results:

• The prospective outcome of a critically ischaemic limb remains largely unknown.
• The current definition of CLI, even with haemodynamic measurements, offers limited predictive value.
• The Fontaine classification is deemed sufficient for clinical practice but inadequate for scientific research.

Conclusions:

• The unpredictability of outcomes underscores the "critical" nature of CLI.
• For scientific purposes, CLI assessment requires additional macro- and microcirculatory data and patient risk profiling.
• Clinical management can rely on the Fontaine classification, but research demands more comprehensive evaluation.