Chronic limb threatening ischemia (CLTI) describes the end stage of peripheral arterial disease (PAD) where severely diminished perfusion, often the result of multilevel arterial disease, becomes incapable of sustaining viable tissue.1 In patients it can be characterized by pain at rest, gangrene, or non-healing ulcerations. CLTI arises in less than 20% of patients affected by PAD, and annually afflicts about 1.28% of the general population over the age of 40, representing 2 million people in the United States alone.2,3 If left untreated, CLTI will eventually progress to amputation, an expensive and debilitating outcome that frequently results in poor functional status and a significantly reduced quality of life among affected patients.4 Despite significant advances in available endovascular therapies, these end points have unfortunately persisted, boasting annual amputation rates as high as 20% and with 1 year mortality often exceeding 40% in those with CLTI.4

Despite advances in endovascular technology, amputation rates continue to increase within subgroups including rural communities, residents of southern geographical regions, racial and ethnic minority populations, and persons of low socioeconomic status.5 A recent study reviewing the 3-year outcomes following a peripheral vascular intervention, Black and Hispanic patients were found to have higher rates of amputation, reintervention, and 30-day major adverse limb events (MALE).6 Within these same patient groups, a higher rate of significant comorbidities and risk factors for CLTI have been demonstrated, resulting in more advanced vascular disease at the time of initial presentation.7,8 And though the prevalence of CLTI is higher among non-Hispanic white patients, the rate of amputation among all minority patients, including Black, Native American, Asian/Pacific Islander, Hispanic groups, is disproportionately higher compared to non-Hispanic white patients by as much as 20%.9 The disparities in outcomes among specific groups of patients has been observed within numerous studies deriving results from multiple data sources effectively confirming these concerning trends in outcomes and thus identifying specific populations most in need of targeted efforts for limb salvage outreach.7,8,9

Though the disparities in these populations have been well documented, elucidating the specific source of the disparities has been more complex.10 Prior studies propose that disparate outcomes in these populations arise due to increased rates of comorbidities such as hypertension, smoking, and diabetes.10 For patients with evidence of CLTI, the Society for Vascular Surgery (SVS) Global Guidelines for the management of CLTI recommend initiation of best medical therapy for management of comorbid factors contributing to worsening peripheral arterial disease along with screening and prompt presentation to a vascular specialist for evaluation.11 Unfortunately, presentation to a vascular specialist late in the progression of disease when gangrene or ulceration is present is common in the aforementioned-subgroups and is associated with higher rates of amputation than those who are evaluated sooner.12 As health-related outcomes are often determined by access to care, improving access in person or remotely can provide patients with the specialty care required for limb salvage.8,13 It is evident then that improving access to vascular care is essential for those at risk of limb loss related to CLTI. A targeted telehealth program represents a successful and underutilized modality to increase patient access to all types of vascular care through remote means.14