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Chronic limb-threatening ischemia
What's new
Updated 2024 ESC guidelines for the diagnosis and management of chronic limb-threatening ischemia .
Background
Overview
Definition
CLTI, also known as critical limb ischemia, is a severe form of PAD characterized by ischemia and tissue necrosis due to inadequate blood flow to the extremities.
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Pathophysiology
The pathophysiology of CLTI primarily involves inadequate blood supply to the limb tissues due to atherosclerosis, thrombosis, or embolism, leading to tissue hypoxia and ischemia.
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Epidemiology
The annual incidence of CLTI is estimated at 36.2 per 100,000 population, with rates as high as 330 per 100,000 population in the elderly.
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Risk factors
Risk factors for CLTI include advanced age, diabetes, smoking, hypertension, renal failure, HF, history of stroke, prior open revascularization, and multiple reinterventions after lower extremity revascularization for claudication.
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Disease course
CLTI is characterized by non-healing ulcers, gangrene, and severe limb pain, often at rest.
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Prognosis and risk of recurrence
The prognosis of CLTI is often poor, with high mortality rates and a significant risk of major amputation. The risk of major amputation (above the ankle) or death, or both, ranges between 20% and 40% at 1 year in untreated cases.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of chronic limb-threatening ischemia are prepared by our editorial team based on guidelines from the European Society of Cardiology (ESC 2024), the Vascular and Endovascular Surgery Society (VESS/SCAI/ABC/SVM/SVN/SVS/AHA/AACVPR/ACC/APMA/SIR 2024), the Canadian Cardiovascular Society (CCS 2022), the Society for Vascular Surgery (SVS 2019), and the European Society of Cardiology (ESC/ESVS 2018).
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