Treatment
20
Summary of Recommendations
Recommendation
Grade/
LOE
6.35 Consider endovascular revascularization for high-risk patients with
advanced limb threat (eg, WIf I stage 4) 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, when technically feasible.
2-C
6.36 Consider endovascular revascularization for high-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, when technically feasible.
2-C
6.37 Consider open surgery in selected high-risk patients with advanced
limb threat (eg, WIf I stage 3 and 4), significant perfusion deficits
(ischemia grade 2 or 3), and advanced complexity of disease (eg,
GLASS stage III) or aer prior failed endovascular attempts and
unresolved symptoms of CLTI.
2-C
6.38 Consider angiosome-guided revascularization in patients with
significant wounds (eg, WIf I wound grades 3 and 4), particularly those
involving the midfoot or hindfoot, and when the appropriate TAP is
available.
2-C
6.39 In treating FP disease in CLTI patients by endovascular means, consider
adjuncts to balloon angioplasty (eg, stents, covered stents, or drug-
eluting technologies) when there is a technically inadequate result or in
the setting of advanced lesion complexity (eg, GLASS FP grade 2–4).
2-B
6.40 Use autologous vein as the preferred conduit for infrainguinal bypass
surgery in CLTI.
1-B
6.41 Avoid using a nonautologous conduit for infrainguinal bypass unless
there is no endovascular option and no adequate autologous vein.
2-C
6.42 Perform intraoperative imaging (angiography, DUS, or both) on
completion of open bypass surgery for CLTI and correct significant
technical defects if feasible during the index operation.
1-C
7. Nonrevascularization treatments of the limb
7.1 Consider SCS to reduce the risk of amputation and to decrease pain
in carefully selected patients (eg, rest pain, minor tissue loss) in whom
revascularization is not possible.
2-B
7.2 Do NOT use LS for limb salvage in CLTI patients in whom
revascularization is not possible.
2-C
7.3 Consider IPC therapy in carefully selected patients (eg, rest pain, minor
tissue loss) in whom revascularization is not possible.
2-B
