21
Summary of Recommendations
Recommendation
Grade/
LOE
7.4 Do NOT offer prostanoids for limb salvage in CLTI patients. Consider
offering selectively for patients with rest pain or minor tissue loss and in
whom revascularization is not possible.
2-B
7.5 Do NOT offer vasoactive drugs or defibrinating agents (ancrod) in
patients in whom revascularization is not possible.
1-C
7.6 Do NOT offer HBOT to improve limb salvage in CLTI patients with
ischemic ulcers in whom revascularization is not possible.
1-A
7.7 Continue to provide optimal wound care until the lower extremity
wound is completely healed or the patient undergoes amputation.
GPS
8. Biologic and regenerative medicine approaches in CLTI
8.1 Restrict use of therapeutic angiogenesis to CLTI patients who are
enrolled in a registered clinical trial.
1-B
9. e role of minor and major amputations
9.1 Consider transmetatarsal amputation of the forefoot in CLTI patients
who would require more than two digital ray amputations to resolve
distal necrosis, especially when the hallux is involved.
2-C
9.2 Offer primary amputation to CLTI patients who have a pre-existing
dysfunctional or unsalvageable limb, a poor functional status (eg,
bedridden), or a short life expectancy aer shared decision-making with
the patient and health care team.
1-C
9.3 Consider secondary amputation for patients with CLTI who have
a failed or ineffective reconstruction and in whom no further
revascularization is possible and who have incapacitating pain,
nonhealing wounds, or uncontrolled sepsis in the affected limb aer
shared decision-making with the patient and health care team.
2-C
9.4 Consider revascularization to improve the possibility of healing an
amputation at a more distal functional amputation level (eg, AKA to
BKA), particularly for patients with a high likelihood of rehabilitation
and continued ambulation.
2-C
9.5 Consider a TKA or AKA in patients who are nonambulatory for reasons
other than CLTI (ie, bedridden patients with flexion contracture, dense
hemiplegia, cancer) and are unlikely to undergo successful rehabilitation
to ambulation.
2-C
