22
Treatment
Table 32. Surgical Revascularization for CLI
COR LOE
Recommendations
I A When surgery is performed for CLI, bypass to the popliteal or
infrapopliteal arteries (i.e., tibial, pedal) should be constructed
with suitable autogenous vein.
I C-LD Surgical procedures are recommended to establish in-line blood
flow to the foot in patients with non-healing wounds or gangrene.
IIa B-NR In patients with CLI for whom endovascular revascularization
has failed and a suitable autogenous vein is not available,
prosthetic material can be effective for bypass to the below-knee
popliteal and tibial arteries.
IIa C-LD A staged approach to surgical procedures is reasonable in patients
with ischemic rest pain.
Table 33. Wound Healing Therapies for CLI
COR LOE
Recommendations
I B-NR An interdisciplinary care team should evaluate and provide
comprehensive care for patients with CLI and tissue loss to
achieve complete wound healing and a functional foot.
I C-LD In patients with CLI, wound care aer revascularization should
be performed with the goal of complete wound healing.
IIb B-NR In patients with CLI, intermittent pneumatic compression
(arterial pump) devices may be considered to augment wound
healing and/or ameliorate severe ischemic rest pain.
IIb C-LD In patients with CLI, the effectiveness of hyperbaric oxygen
therapy for wound healing is unknown.
III: No
Benefit
B-R Prostanoids are NOT indicated in patients with CLI.
Management of ALI
Table 34. Clinical Presentation of ALI
COR LOE
Recommendations
I C-EO Patients with ALI should be emergently evaluated by a clinician
with sufficient experience to assess limb viability and implement
appropriate therapy.
I C-LD In patients with suspected ALI, initial clinical evaluation should
rapidly assess limb viability and potential for salvage and does not
require imaging.
