Urgent need to clarify the definition of chronic critical limb ischemia - a position paper from the European Society for Vascular Medicine.
Details
Serval ID
serval:BIB_3B39C4151151
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Urgent need to clarify the definition of chronic critical limb ischemia - a position paper from the European Society for Vascular Medicine.
Journal
VASA. Zeitschrift fur Gefasskrankheiten
ISSN
0301-1526 (Print)
ISSN-L
0301-1526
Publication state
Published
Issued date
05/2019
Peer-reviewed
Oui
Volume
48
Number
3
Pages
223-227
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
<b></b> Chronic critical lower limb ischemia (CLI) has been defined as ischemia that endangers the leg. An attempt was made to give a precise definition of CLI, based on clinical and hemodynamic data (Second European Consensus). CLI may be easily defined from a clinical point of view as rest pain of the distal foot or gangrene or ulceration. It is probably useful to add leg ulcers of other origin which do not heal because of severe ischemia, and to consider the impact of frailty on adverse outcome. From a hemodynamic viewpoint there is no consensus and most of the existing classifications are not based upon evidence. We should thus propose a definition and then validate it in a prospective cohort in order to define the patients at major risk of amputation, and also to define the categories of patients whose prognosis is improved by revascularisation. From today's available data, it seems clear that the patients with a systolic toe pressure (STP) below 30 mmHg must be revascularised whenever possible. However other patients with clinically suspected CLI and STP above 30 mmHg must be evaluated and treated in specialised vascular units and revascularisation has to be discussed on a case by case basis, taking into account other data such as the WiFi classification for ulcers.In conclusion, many useful but at times contradictory definitions of CLI have been suggested. Only a few have taken into account evidence, and none have been validated prospectively. This paper aims to address this and to give notice that a CLI registry within Europe will be set up to prospectively validate, or not, the previous and suggested definitions of CLI.
Keywords
Amputation, Europe, Extremities, Humans, Ischemia, Peripheral Vascular Diseases, Prospective Studies, Treatment Outcome, Critical limb ischemia, ankle pressure, definition, oxygen transcutaneous pressure, peripheral arterial disease, toe pressure
Pubmed
Web of science
Create date
26/11/2018 13:52
Last modification date
20/08/2019 13:31