17
Summary of Recommendations
Recommendation
Grade/
LOE
5. e GLASS for CLTI
5.1 Use an integrated, limb-based anatomic staging system (such as the
GLASS) to define complexity of a preferred TAP and to facilitate EBR
in patients with CLTI.
GPS
6. Strategies for EBR
6.1 Refer all patients with suspected CLTI to a vascular specialist for
consideration of limb salvage, unless major amputation is considered
medically urgent.
GPS
6.2 Offer primary amputation or palliation to patients with limited
life expectancy, poor functional status (eg, nonambulatory), or an
unsalvageable limb aer shared decision-making.
GPS
6.3 Estimate periprocedural risk and life expectancy in patients with CLTI
who are candidates for revascularization.
1-C
6.4 Define a CLTI patient as average surgical risk when anticipated
periprocedural mortality is <5% and estimated 2-year survival is >50%.
2-C
6.5 Define a CLTI patient as high surgical risk when anticipated
periprocedural mortality is ≥5% or estimated 2-year survival is >50%.
2-C
6.6 Use an integrated threatened limb classification system (such as WIf I) to
stage all CLTI patients who are candidates for limb salvage.
1-C
6.7 Perform urgent surgical drainage and débridement (including minor
amputation if needed) and commence antibiotic treatment in all patients
with suspected CLTI who present with deep space foot infection or wet
gangrene.
GPS
6.8 Repeat limb staging aer surgical drainage, débridement, minor
amputations, or correction of inflow disease (AI, common and deep
femoral artery disease) and before the next major treatment decision.
GPS
6.9 Do NOT perform revascularization in the absence of significant
ischemia (WIf I ischemia grade 0) unless an isolated region of poor
perfusion in conjunction with major tissue loss (eg, WIf I wound grade
2 or 3) can be effectively targeted and the wound progresses or fails to
reduce in size by ≥50% within 4 weeks despite appropriate infection
control, wound care, and ooading.
GPS
6.10 Do NOT perform revascularization in very-low–risk limbs (eg, WIf I
stage 1) unless the wound progresses or fails to reduce in size by ≥50%
within 4 weeks despite appropriate infection control, wound care, and
ooading.
2-C
