5
Figure 3. PLAN framework of clinical decision-making in
CLTI; infrainguinal disease
Patient with CLTI
Stage severity of limb
threat (WIfI)
Estimate procedural
risk/2-yr survival
Primary
amputation
Candidate for
limb salvage?
YES
a
Refer to Fig 6 for preferred revascularization strateg y in standard-risk patients with available vein
conduit, based on limb stage at presentation and anatomic complexity. Approaches for patients
lacking suitable vein are reviewed in the text.
Wound care,
surveillance for
deterioration
Low limb risk
(WIfI stage 1)
Intermediate or higher
limb threat (WIfI stage >2)
Palliation/
wound care
NO
Consider need for
revascularization
Anatomic staging of disease (Global Limb
Anatomic Staging System [GLASS])
YES
No option for
revascularization
No or unclear need
Perform endovascular
intervention if possible
Determine vein conduit status
(eg, ultrasound mapping)
Revascularize using preferred
strategy (endo or open)
Revascularization
feasible
High risk
patient
Standard risk
patient
