New global guideline on critical limb-threatening ischaemia finalised, awaiting publication

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The long-awaited Global Vascular Guidelines for chronic limb-threatening ischaemia have been finalised, with the comprehensive guideline set to be published shortly. The news were announced by the Society for Vascular Surgery, one of the societies—alongside the European Society for Vascular Surgery, the World Federation of Vascular Societies, and others—participating in the international effort to produce the document.

The European Journal of Vascular and Endovascular Surgery (EJVES) and the Journal of Vascular Surgery (JVS) are simultaneously publishing the guideline, with 113 specific recommendations, as a supplement to the June edition. It will be made available online before late May, according to the Society for Vascular Surgery’s newspaper, Vascular Specialist.

The Society for Vascular Surgery (SVS) reports the the guideline “creates a new conceptual framework for treating chronic limb-threatening ischaemia, the end-stage of peripheral arterial disease. The document encompasses nomenclature, disease staging and a platform for evidence-based revascularisation that will allow for future evolution and quality improvement in the field.” Furthermore, a notable change is a purposeful move from the term critical limb ischaemia (CLI) to chronic limb-threatening ischaemia (CLTI): a name which the authors explain is a better reflection of the full spectrum of the disease.

Michael Conte of the Society from Vascular Surgery, Philippe Kolh of the European Society for Vascular Surgery and Andrew Bradbury of the the World Federation of Vascular Societies co-edited the guidelines document, with close to 60 additional authors. All specialties treating CLI were represented among the authors, the SVS notes, with participants from six continents. Highlighting the thorough and methodical work of the writing group, the finalised document is “a unique practice guideline, reflecting the spectrum of the disease and approaches seen worldwide,” Conte told the SVS.

The SVS further discloses that major recommendations will cover the need for comprehensive assessments in patients with suspected CLTI; optimal medical therapy, including a variety of treatments for CLTI patients; and prompt and effective revascularisation for patients with advanced ischaemia and limb threat. The document also outlines the importance of an individualised approach to improve patient care and reduce limb loss. Other significant changes include a standardised classification system with endorsement of the SVS Threatened Limb Classification System based on grading wound, ischaemia and foot infection (WIfI) in the affected limb, as well as introducing the Global Limb Anatomic Staging System (GLASS) to stratify patterns of arterial occlusive disease.

“Perhaps most notably, the guideline supports a structured approach to decision-making regarding revascularisation based on Patient risk, Limb severity and ANatomic complexity (PLAN), in that order of priority,” Conte comments in the SVS announcement. “The guideline seeks to provide a new foundation for practice but also for data collection to support evidenced-based revascularisation in CLTI.”

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