Multidisciplinary Care for Critical Limb Ischemia: Current Gaps and Opportunities for Improvement

J Endovasc Ther. 2019 Apr;26(2):199-212. doi: 10.1177/1526602819826593. Epub 2019 Feb 1.

Abstract

Critical limb ischemia (CLI), defined as ischemic rest pain or nonhealing ulceration due to arterial insufficiency, represents the most severe and limb-threatening manifestation of peripheral artery disease. A major challenge in the optimal treatment of CLI is that multiple specialties participate in the care of this complex patient population. As a result, the care of patients with CLI is often fragmented, and multidisciplinary societal guidelines have not focused specifically on the care of patients with CLI. Furthermore, multidisciplinary care has the potential to improve patient outcomes, as no single medical specialty addresses all the facets of care necessary to reduce cardiovascular and limb-related morbidity in this complex patient population. This review identifies current gaps in the multidisciplinary care of patients with CLI, with a goal toward increasing disease recognition and timely referral, defining important components of CLI treatment teams, establishing options for revascularization strategies, and identifying best practices for wound care post-revascularization.

Keywords: critical limb ischemia; endovascular therapy; multidisciplinary care; peripheral artery disease; revascularization; wound care.

Publication types

  • Review

MeSH terms

  • Amputation, Surgical
  • Combined Modality Therapy
  • Critical Illness
  • Endovascular Procedures* / adverse effects
  • Hemodynamics
  • Humans
  • Intermittent Claudication / diagnosis
  • Intermittent Claudication / physiopathology
  • Intermittent Claudication / therapy*
  • Ischemia / diagnosis
  • Ischemia / physiopathology
  • Ischemia / therapy*
  • Leg Ulcer / diagnosis
  • Leg Ulcer / physiopathology
  • Leg Ulcer / therapy*
  • Limb Salvage
  • Patient Care Team
  • Peripheral Arterial Disease / diagnosis
  • Peripheral Arterial Disease / physiopathology
  • Peripheral Arterial Disease / therapy*
  • Recovery of Function
  • Time Factors
  • Treatment Outcome
  • Wound Healing