Digital Subtraction Angiography Prior to an Amputation for Critical Limb Ischemia (CLI): An Expert Recommendation Statement From the CLI Global Society to Optimize Limb Salvage
Jihad A. Mustapha, MD; Fadi A. Saab, MD; Brad J. Martinsen, PhD; Constantino S. Pena, MD; Thomas Zeller, MD; Vickie R. Driver, DPM; Richard F. Neville, MD; Robert Lookstein, MD; Jos C. van den Berg, MD, PhD; Michael R. Jaff, DO; Paul Michael, MD; Steve Henao, MD; Amjad AlMahameed, MD; Barry Katzen, MD
Abstract
Despite recent guideline updates on peripheral artery disease (PAD) and critical limb ischemia (CLI) treatment, the optimal treatment for CLI is still being debated. As a result, care is inconsistent, with many CLI patients undergoing an amputation prior to what many consider to be mandatory: consultation with an interdisciplinary specialty care team and a comprehensive imaging assessment. More importantly, quality imaging is critical in CLI patients with below-the-knee disease. Therefore, the CLI Global Society has put forth an interdisciplinary expert recommendation for superselective digital subtraction angiography (DSA) that includes the ankle and foot in properly indicated CLI patients to optimize limb salvage. A recommended imaging algorithm for CLI patients is included.