|
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. |
|