Recommendation for Revascularization for CLI
COR	LOE	Recommendation
I	B-NR	In patients with CLI, revascularization should be performed when possible to minimize tissue loss.290
See Online Data Supplement 39.		Patients with CLI are at high risk of major cardiovascular ischemic events, as well as nonhealing wounds and major amputation. In a systematic review of 13 studies of patients with CLI who did not receive revascularization, which included patients enrolled in medical and angiogenic therapy trials, there was a 22% all-cause mortality rate and a 22% rate of major amputation at a median follow-up of 12 months.290 The goal of surgical or endovascular revascularization is to provide in-line blood flow to the foot through at least 1 patent artery, which will help decrease ischemic pain and allow healing of any wounds, while preserving a functional limb. Multiple RCTs comparing contemporary surgical and endovascular treatment for patients with CLI are ongoing.15–17 Revascularization is not warranted in the setting of a nonviable limb.
I	C-EO	An evaluation for revascularization options should be performed by an interdisciplinary care team (Table 9) before amputation in the patient with CLI.
N/A		Patients with CLI should be evaluated by an interdisciplinary care team. Before amputation, evaluation generally includes imaging for assessment of revascularization options (eg, duplex ultrasound, CTA, MRA, or catheter-based angiogram). The objective of this strategy is to minimize tissue loss and preserve a functional limb with revascularization.