Treatment
18
Summary of Recommendations
Recommendation
Grade/
LOE
6.11 Offer revascularization to all average-risk patients with advanced limb-
threatening conditions (eg, WIf I stage 4) and significant perfusion
deficits (eg, WIf I ischemia grades 2 and 3).
1-C
6.12 Consider revascularization for average-risk patients with intermediate
limb threat (eg, WIf I stages 2 and 3) and significant perfusion deficits
(eg, WIf I ischemia grades 2 and 3).
2-C
6.13 Consider revascularization in average-risk patients with advanced limb
threat (eg, WIf I stage 4) and moderate ischemia (eg, WIf I ischemia
grade 1).
2-C
6.14 Consider revascularization in average-risk patients with intermediate
limb threat (eg, WIf I stages 2 and 3) and moderate ischemia (eg, WIf I
ischemia grade 1) if the wound progresses or fails to reduce in size by
≥50% within 4 weeks despite appropriate infection control, wound care,
and ooading.
2-C
6.15 Obtain high-quality angiographic imaging with dedicated views of
ankle and foot arteries to permit anatomic staging and procedural
planning in all CLTI patients who are candidates for revascularization.
GPS
6.16 Use an integrated limb-based staging system (eg, GLASS) to define the
anatomic pattern of disease and preferred TAP in all CLTI patients
who are candidates for revascularization.
GPS
6.17 Perform ultrasound vein mapping when available in all CLTI patients
who are candidates for surgical bypass.
1-C
6.18 Map the ipsilateral GSV and small saphenous vein for planning of
surgical bypass. Map veins in the contralateral leg and both arms if
ipsilateral vein is insufficient or inadequate.
GPS
6.19 Do NOT classify a CLTI patient as being unsuitable for
revascularization without review of adequate-quality imaging studies
and clinical evaluation by a qualified vascular specialist.
GPS
6.20 Correct inflow disease first when both inflow and outflow disease are
present in a patient with CLTI.
GPS
6.21 Base the decision for staged vs. combined inflow and outflow
revascularization on patient risk and the severity of limb threat (eg,
WIf I stage).
1-C
6.22 Correct inflow disease alone in CLTI patients with multilevel disease
and low-grade ischemia (eg, WIf I ischemia grade 1) or limited tissue
loss (eg, WIf I wound grade 0/1) and in any circumstance in which the
risk-benefit of additional outflow reconstruction is high or initially
unclear.
1-C
