15
Summary of Recommendations
Recommendation
Grade/
LOE
1. Definitions and nomenclature
1.1 Use objective hemodynamic tests to determine the presence and to
quantify the severity of ischemia in all patients with suspected CLTI.
1-C
1.2 Use a lower extremity threatened limb classification staging system (eg,
SVS's WIf I classification system) that grades wound extent, degree of
ischemia, and severity of infection to guide clinical management in all
patients with suspected CLTI.
1-C
2. Global epidemiology and risk factors for CLTI
No recommendations
3. Diagnosis and limb staging in CLTI
3.1 Perform a detailed history to determine symptoms, past medical history,
and cardiovascular risk factors in all patients with suspected CLTI.
GPS
3.2 Perform a complete cardiovascular physical examination of all patients
with suspected CLTI.
GPS
3.3 Perform a complete examination of the foot, including an assessment of
neuropathy and a probe-to-bone test of any open ulcers, in all patients
with pedal tissue loss and suspected CLTI.
GPS
3.4 Measure AP and ABI as the first-line noninvasive test in all patients with
suspected CLTI.
1-B
3.5 Measure TP and TBI in all patients with suspected CLTI and tissue loss
(Fig 1).
1-B
3.6 Consider using alternative methods for noninvasive assessment of
perfusion, such as PVR, transcutaneous oximetry, or skin perfusion
pressure, when ankle and toe pressures, indices, and waveforms cannot
be assessed.
2-C
3.7 Consider DUS imaging as the first arterial imaging modality in patients
with suspected CLTI.
2-B
3.8 Consider noninvasive vascular imaging modalities (DUS, CTA, MRA)
when available before invasive catheter angiography in patients with
suspected CLTI who are candidates for revascularization.
2-B
3.9 Obtain high-quality angiographic imaging of the lower limb (with
modalities and techniques to be determined by local available facilities
and expertise). is should include the ankle and foot in all patients
with suspected CLTI who are considered potential candidates for
revascularization.
GPS
Treatment
