Chronic Limb Threatening Ischemia (CLTI) represents the end stage of peripheral artery disease (PAD). It is defined as ischemic rest pain or tissue loss in the setting of objectively documented PAD1. When left untreated, CLTI predisposes to significant cardiovascular mortality, disability, and limb loss. Non-revascularizable CLTI has a five-year amputation free survival rate of only 43%, with 35% all cause mortality2. Approaches for the treatment of CLTI encompass multiple aspects of vascular care, including revascularization, management of medical comorbidities, and intensive, ongoing wound care in patients with tissue loss. The concept of appropriate care in the CLTI patient therefore mandates a comprehensive approach, wherein all aspects of care are synthesized under the care of a team of providers across multiple specialties.

Prior to addressing revascularization, patients with CLTI greatly benefit from adequate control of medical comorbidities. Cardiovascular mortality is the highest cause of death in patients with CLTI2. Proper medical management of comorbidities, specifically management of diabetes, antiplatelet and lipid-lowering therapy1,3 confers a mortality benefit that cannot be overlooked. In patients who present with tissue loss, proper wound care is essential to maintain quality of life and life expectancy. Wound care before and after revascularization reduces the incidence of limb and life- threatening infection. Even in patients in whom arterial reconstruction is impossible, wound care plays a significant role in staving off major limb amputation1.

CLTI care is undertaken by multiple medical specialties and care guidelines are non-standardized. This review aims to summarize the currently available guidelines for care of patients with CLTI, outcomes to delineate Appropriateness of Care, the prevalence of standardized treatment guidelines and how they impact practice, and how multidisciplinary care and vascular surveillance can benefit the CLTI patient population.