Contemporary Chronic Limb-Threatening Ischemia Care in the United States—Part 1: A Path Toward Multispecialty Collaboration

TL;DR

This paper discusses improving care for chronic limb-threatening ischemia through multispecialty collaboration in the U.S.

Contribution

It proposes expanding CLTI care teams beyond traditional specialties to include additional disciplines and care settings.

Findings

Integrated CLTI care teams should include vascular medicine, podiatry, wound care, diabetology, and dietetics.

Meeting the demand for CLTI revascularization requires collaboration across various healthcare settings.

A multispecialty approach is essential to address challenges in CLTI care delivery and access.

Abstract

Care for patients with chronic limb-threatening ischemia (CLTI) is complex, and it is most effective when conducted with collaboration across multiple specialties. A recent upward trend in major limb amputation among patients with CLTI warrants a renewed effort to optimize care for this multifaceted condition. The Vascular InterVentional Advances (VIVA) Foundation, a not-for-profit 501(c)(3) organization, convened a Vascular Leaders Forum in 2024 to initiate an open, multispecialty discussion about the state of CLTI care in the United States and current challenges around delivery and access to such care. The forum comprised representatives from vascular surgery, interventional cardiology, interventional radiology, vascular medicine, podiatry, regulators, medical device manufacturers, patient advocacy, and the CLTI and CLTI caregiver population. This article explores the central themes of challenges in CLTI care and ways in which collaboration across specialties and care settings could improve CLTI outcomes. In summary, it was recommended that integrated CLTI care teams extend beyond vascular surgery, interventional cardiology, and interventional radiology to include vascular medicine, podiatry, wound care, diabetology, and dietetics. Meeting the increasing demand for CLTI revascularization will require these teams to span tertiary care hospitals, community hospitals, outpatient revascularization clinics, and primary care settings.

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