19
Summary of Recommendations
Recommendation
Grade/
LOE
6.23 Restage the limb and repeat the hemodynamic assessment aer
performing inflow correction in CLTI patients with inflow and outflow
disease.
1-C
6.24 Consider simultaneous inflow and outflow revascularization in CLTI
patients with a high limb risk (eg, WIf I stages 3 and 4), or in patients
with severe ischemia (eg, WIf I ischemia grades 2 and 3).
2-C
6.25 Use an endovascular-first approach for treatment of CLTI patients with
moderate to severe (eg, GLASS stage IA) AI disease, depending on the
history of prior intervention.
1-B
6.26 Consider surgical reconstruction for the treatment of average-risk
CLTI patients with extensive (eg, GLASS stage II) AI disease or aer
failed endovascular intervention.
2-C
6.27 Perform open CFA endarterectomy with patch angioplasty,
with or without extension into the PFA, in CLTI patients with
hemodynamically significant (>50% stenosis) disease of the common
and deep femoral arteries.
1-C
6.28 Consider a hybrid procedure combining open CFA endarterectomy
and endovascular treatment of AI disease with concomitant CFA
involvement (GLASS stage IB).
2-C
6.29 Consider endovascular treatment of significant CFA disease in selected
patients who are deemed to be at high surgical risk or to have a hostile
groin.
2-C
6.30 Avoid stents in the CFA and do NOT place stents across the origin of a
patent deep femoral artery.
GPS
6.31 Correct hemodynamically significant (≥50% stenosis) disease of the
proximal deep femoral artery whenever technically feasible.
GPS
6.32 In average-risk CLTI patients with infrainguinal disease, base decisions
of endovascular intervention vs. open surgical bypass on the severity of
limb threat (eg, WIf I), the anatomic pattern of disease (eg, GLASS),
and the availability of autologous vein.
1-C
6.33 Offer endovascular revascularization when technically feasible for
high-risk patients with advanced limb threat (eg, WIf I stage 4) and
significant perfusion deficits (eg, WIf I ischemia grades 2 and 3).
2-C
6.34 Consider endovascular revascularization for high-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
