FINANCIAL DISCLOSURES

Employment No conflict of interest to disclose

Research support Bayer, Daiichi Sankyo, Pfizer

DSMB Pluristem

Consultancy No conflict of interest to disclose

Speakers bureau No conflict of interest to disclose

Major stockholder No conflict of interest to disclose

Patents No conflict of interest to disclose

Honoraria Bayer, Italfarmaco, Alfa

Wassermann, Aspen

Travel support No conflict of interest to disclose

Other No conflict of interest to

disclose

PAD (Tasc 2017, AHA 2016) / LEAD (ESC 2011, ESC ESVS 2017)

CLI - CTLI

Sopravvivenza a lungo termine in pazienti con

arteriopatia periferica

Criqui MH et al. N Engl J Med 1992;326:381-6

Normali

Arteriopatia asintomatica

Arteriopatia sintomatica

Arteriopatia sintomatica grave

100

75

50

25

0 2 4 6 8 10 12

So

pra

vv

iven

za (

%)

Anni

BEST MEDICAL THERAPY

AHA 2016, ESC, ESVS 2017

Critical Limb Ischemia (CLI) TASC 2007, AHA 2015

Chronic limb-threatening ischaemiaESC /ESVS 2017

• Clinical patterns with a threatened

limb viability related to several factors

• In contrast to the former term ‘critical

limb ischaemia’, severe ischaemia is

not the only underlying cause.

Critical Limb Ischemia (CLI) TASC 2007

Chronic limb-threatening ischaemiaESC/ESVS 2017

1^ Critical’ implies that treatment is urgent to avoid

limb loss, while some patients can keep their legs for long

periods of time even in the absence of revascularization

2^ The increasing predominance of diabetes in these situations,

present in 50–70% of cases, presents mostly as neuro-ischaemic

diabetic foot ulcers

3^ The risk of amputation not only depends on the severity of

ischaemia, but also the presence of a wound and infection. This

explains why ankle or toe pressures, measured to address LEAD

severity, are not a definition component of CLTI.

CLTI: severity and risk stratification The Wound Ischemia Foot Infection classification: Target population

• Ischaemic rest pain, typically in the forefoot with objectively confirmed haemodynamic studies (ABI <0.40, ankle pressure <50mmHg, toe pressure <30 mmHg, TcPO2 <30mmHg)

• Diabetic foot ulcer

• Non-healing lower limb or foot ulceration > 2 weeks duration or

• Gangrene involving any portion of the foot or lower limb

ESC/ESVS 2017

Mills, J Vasc Surg 2014

DECISION MAKING NEL

PAZIENTE CON CLI

PLAN

• Patient risk

• Limb threat severity (class. WIFI)

• ANatomic pattern (class. GLASS)

GLASS CLASSIFICATION

STADIO

GLASS

INSUCCESSO

TECNICO

PERVIETA’ AD

UN ANNO

I <10% >70%

II 10-20% 50-70%

III >20% >50%

Global Vascular Guidelines on CLTI, presented at the 2017 ESVS Annual Meeting

ESC/ ESVS 2017

EJVES 2017

Interdisciplinary care team for

PAD>CLI

AHA, 2016

Grazie per Attenzione!