The draft Global Vascular Guidelines on chronic limb threatening ischaemia (CLTI) have just been posted for open public comment until 3 December 2018. Michael S Conte (San Francisco, USA), one of the co-editors of the guidelines, told Vascular News at VEITHsymposium 2018 that there needs to be a pivot from a “lesion-first” mentality to evidence-based revascularisation, which involves thinking about the patient, the limb and the anatomy—in that order. The draft guideline materials are available at http://vsweb.org/GlobalVascularGuidelines.