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Treatment
10.2. Revascularization for CLTI
COR LOE
Recommendations
Revascularization Goals for CLTI
1 B-R
1. In patients with CLTI, surgical, endovascular, or hybrid
revascularization techniques are recommended, when
feasible, to minimize tissue loss, heal wounds, relieve pain,
and preserve a functional limb.
1 C-EO
2. In patients with CLTI, an evaluation for revascularization
options by a multispecialty care team is recommended before
amputation (Table 15).
Revascularization Strategy for CLTI
1 A
3. In patients undergoing surgical revascularization for CLTI,
bypass to the popliteal or infrapopliteal arteries (ie, tibial,
pedal) should be constructed with autogenous vein if available.
1 B-R
4. In patients with CLTI due to infrainguinal disease, anatomy,
available conduit, patient comorbidities, and patient
preferences should be considered in selecting the optimal first
revascularization strateg y (surgical bypass or endovascular
revascularization) (Table 16).
1 B-R
5. In patients with CLTI who are candidates for surgical bypass
and endovascular revascularization, ultrasound mapping of
the great saphenous vein is recommended.
2a B-NR
6. In patients with CLTI for whom a surgical approach is
selected and a suitable autogenous vein is unavailable,
alternative conduits such as prosthetic or cadaveric grafts can
be effective for bypass to the popliteal and tibial arteries.
2a B-NR
7. In patients with CLTI and nonhealing wounds or gangrene,
revascularization in a manner that achieves in-line blood flow
or maximizes perfusion to the wound bed can be beneficial.
2a C-LD
8. In patients with CLTI with ischemic rest pain (ie, without
nonhealing wounds or gangrene) attributable to multilevel
arterial disease, a revascularization strateg y addressing inflow
disease first is reasonable.
