SCAI/ACR/APMA/SCVS/SIR/SVM/SVS/VESS Position Statement on Competencies for Endovascular Specialists Providing CLTI Care

Abstract

Chronic limb-threatening ischemia (CLTI) is the advanced stage of peripheral artery disease (PAD) characterized by rest pain or tissue loss. Up to 2 million individuals have this condition in the United States, and prevalence is anticipated to grow owing to aging of the population and increase in atherosclerotic risk factors such as diabetes and renal disease.1 In addition to the threat of limb dysfunction and amputation, patients with CLTI are at a high risk of cardioand cerebrovascular morbidity and mortality, with risk that exceeds that of most other cardiovascular patients. Within 1 year, 1 in 5 CLTI patients dies, and an additional one quarter will require major limb amputation.2 Care of the CLTI patient is complex, multifaceted, and multidisciplinary. Medical therapy, wound care, interpretation of noninvasive and invasive vascular testing, and the performance of revascularization procedures are integral to achieve limb salvage. Both surgical and endovascular revascularization have been established as effective treatment modalities that alleviate symptoms and promote healing. Decisions regarding revascularization strategy for individual patients are nuanced and depend in part on comorbidities, anatomy, functional status, conduit availability, presence of suitable bypass target, and other factors. Endovascular revascularization is performed by physicians across a variety of disciplines including vascular surgeons— the only specialty providing both endovascular and open surgical intervention—interventional radiologists, interventional cardiologists, and others.3 Irrespective of specialty, the endovascular specialist focused on CLTI should understand the role of surgical revascularization, understand the likelihood of short-term and long-term success with each type of revascularization, possess competencies that extend beyond catheter-based therapies, and integrate other CLTI SCAI/ACR/APMA/SCVS/SIR/SVM/SVS/VESS Position Statement on Competencies for Endovascular Specialists Providing CLTI Care