PMID- 33032494
OWN - NLM
STAT- MEDLINE
DCOM- 20210624
LR  - 20221207
IS  - 1545-1550 (Electronic)
IS  - 1526-6028 (Linking)
VI  - 28
IP  - 2
DP  - 2021 Apr
TI  - A Review and Proposed Classification System for the No-Option Patient With 
      Chronic Limb-Threatening Ischemia.
PG  - 183-193
LID - 10.1177/1526602820963911 [doi]
AB  - A growing, but poorly defined subset of patients with chronic limb-threatening 
      ischemia (CLTI) have "no option" for revascularization. One notable subgroup 
      includes patients with severe ischemia and advanced pedal artery occlusive 
      disease, termed "desert foot," who are at high risk for major amputation due to a 
      lack of conventional revascularization options. Although new therapies are being 
      developed for no-option patients with desert foot anatomy, this subgroup and the 
      broader group of no-option patients are not well defined, limiting the ability to 
      evaluate outcomes. Based on a systematic review, a classification of the 
      no-option CLTI patient was constructed for use in clinical practice and studies. 
      Several no-option conditions were identified, including type I-severe and pedal 
      occlusive disease (desert foot anatomy) for which there is no accepted method of 
      repair; type II-lack of suitable venous conduit for bypass in the setting of an 
      acceptable target for bypass; type III-extensive tissue loss with exposure of 
      vital structures that renders salvage impossible; type IV-advanced medical 
      comorbidities for which available revascularization options would pose a 
      prohibitive risk; and type V-presence of a nonfunctional limb. While type I and 
      type II patients may have no option for revascularization, type III and type V 
      patients have wounds, infection, comorbidities, or functional status that may 
      leave them with few options for revascularization. As treatment strategies 
      continue to evolve and novel methods of revascularization are developed, the 
      ability to identify no-option patients in a standardized fashion will aid in 
      treatment selection and assessment of outcomes.
FAU - Kim, Tanner I
AU  - Kim TI
AUID- ORCID: 0000-0002-7524-2894
AD  - Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New 
      Haven, CT, USA.
FAU - Vartanian, Shant S
AU  - Vartanian SS
AD  - Division of Vascular and Endovascular Surgery, University of California at San 
      Francisco School of Medicine, San Francisco, CA, USA.
FAU - Schneider, Peter A
AU  - Schneider PA
AD  - Division of Vascular and Endovascular Surgery, University of California at San 
      Francisco School of Medicine, San Francisco, CA, USA.
LA  - eng
PT  - Journal Article
DEP - 20201009
PL  - United States
TA  - J Endovasc Ther
JT  - Journal of endovascular therapy : an official journal of the International 
      Society of Endovascular Specialists
JID - 100896915
SB  - IM
MH  - Amputation, Surgical
MH  - Chronic Disease
MH  - Humans
MH  - Ischemia/diagnostic imaging/surgery
MH  - *Limb Salvage
MH  - *Peripheral Arterial Disease/surgery/therapy
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Systematic Reviews as Topic
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - amputation
OT  - bypass graft
OT  - comorbidities
OT  - critical limb ischemia
OT  - desert foot
OT  - endovascular therapy
OT  - infection
OT  - ischemic wound
OT  - limb salvage
OT  - peripheral vascular disease
OT  - revascularization
OT  - tissue loss
EDAT- 2020/10/10 06:00
MHDA- 2021/06/25 06:00
CRDT- 2020/10/09 05:24
PHST- 2020/10/10 06:00 [pubmed]
PHST- 2021/06/25 06:00 [medline]
PHST- 2020/10/09 05:24 [entrez]
AID - 10.1177/1526602820963911 [doi]
PST - ppublish
SO  - J Endovasc Ther. 2021 Apr;28(2):183-193. doi: 10.1177/1526602820963911. Epub 2020 
      Oct 9.