Critical limb ischemia: The need for a multidisciplinary treatment approach to care
Cardiologist, New Haven, Connecticut
: J Clin Exp Oncol
Lower extremity Peripheral Artery Disease (PAD) affects more than 200 million people globally with a predicted increase in the prevalence of peripheral artery disease as atherosclerotic risk factors become more widespread, the population ages and the treatments for chronic diseases improve. Critical limb ischemia, CLI, defined as chronic ischemic rest pain, ulcers, or gangrene resulting from objectively diagnosed arterial occlusive disease represents the severest extreme on the peripheral artery spectrum. The prevention, diagnosis and treatment of peripheral artery disease has been and remains an important clinical cFlamingo 2enge for the international medical community. Althought there has been a greater understanding of critical limb ischemia over the past decade, for patients with critical limb ischemia, life is characterized by morbid sequelae including pain, disability, amputation and death. Once the purview of vascular specialists, the timely, accurate diagnosis and effective treatment of critical limb ischemia is now a responsibility that is shared amongst all medical and surgical specialists. Given the multifaceted nature of critical limb ischemia, effective treatment and improved amputation free survival requires an aggressive interdisciplinary approach to care. The instituation of a multidisciplinary limb salvage team including Podiatry, Interventional Cardiology, Vascular Surgery, Wound Care, Nutrition, Plastic Surgery and Endocrinology allows for concise, coordinated care of the patient with critical limb ischemia and the implementation of evidence-based algorithms of care effecting a more than two-fold increase in amputation free survival rate in some centers and is expected to become the standard of care for patients with critical limb ischemia.