Informed Decision Making In CLTI

Location: McCormick Place West Building 2301 S. Indiana Ave, Chicago, IL


This session on Informed Decision Making in CLTI will be held during VAM24. It will be helpful in expanding physician knowledge base and improving clinical confidence and effectiveness in treating patients with CLTI. This session will focus on shared, patient-centered decision making to individualize treatment recommendations. The importance of staging and setting patients’ expectations to facilitate decision making for CLTI patients will be reviewed.

Breakfast will be provided at no cost to attendees, but pre-registration is requested.

Funding for this activity is provided by a grant from CMSS aimed to promote diagnostic excellence across the field of medicine.

CMSS logo

Learning Objectives

  • Review the PLAN (Patient risk, Limb severity, ANatomic complexity of disease) algorithm for shared, patient-centered decision making in chronic limb threatening ischemia (CLTI).
  • Learn how to manage patient expectations throughout the limb preservation process.
  • Learn how to present appropriate options to your patients and customize information to meet patient goals and avoid undesirable outcomes.
  • Be able to describe approaches to shared decision making in complex CLTI scenarios, including consideration of palliative wound care.

To evaluate effectiveness in reaching learning objectives, a short survey will be conducted before and after the session, and a follow-up survey will be conducted in 60 days.


7:00-7:10AM Introduction and Overview, Dr. Conte
7:10-7:20AM How to use WIfI to triage acuity and provide prognostic information to patients with CLTI patients, Dr. Abularrage
7:20-7:30AM Setting the expectation about foot reconstruction and recovery in CLTI patients, Dr. Armstrong
7:30-7:40AM Identifying high risk patients and offering palliative wound care as a treatment option, Dr. Humphries
7:40-8:00AM Panel Discussion with Live Patients and Drs. Conte, Mills, Humphries, Armstrong, O‘Banion, and Abularrage

Moderators and Faculty

Michael Conte Headshot

Michael Conte, MD

Professor and Chief, Division of Vascular and Endovascular Surgery

E.J. Wylie Chair, Co-Director, Heart and Vascular Center and Limb Preservation and Diabetic Foot

University of California, San Francisco 

Joe Mills Headshot

Joseph L. Mills, MD, FACS

Professor and Chief, Division of Vascular & Endovascular Therapy

Michael E. DeBakey Department of Surgery 

Baylor College of Medicine

Misty Humphries headshot

Misty D. Humphries, MD, MAS, RPVI

Associate Professor of Surgery; Interim Chief, Division of Vascular Surgery

UC Davis

David Armstrong Headshot

David G. Armstrong, DPM, MD, PhD

Professor of Surgery

University of Southern California

Founder & Co-Director

Southwestern Academic Limb Salvage Alliance

Leigh Ann O'Banion headshot

Leigh Ann O'Banion, MD 

Associate Professor of Surgery 

University of California San Francisco-Fresno

Christopher Abularrage headshot

Christopher Abularrage, MD

The Bertram M. Bernheim Professor of Surgery & Fellowship Program Director

Vascular & Endovascular Therapy

Johns Hopkins University

Recommended Reading

  1. Mills Sr JL, Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN, et al. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg 2014;59:220e234.e1-2.
  2. Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, Mills JL, Ricco JB, Suresh KR, Murad MH. Global vascular guideline on the management of chronic limb-threatening ischemia. J Vasc Surg. 2019;69(6s):1-122.
  3. Armstrong DG, Tan TW, Boulton AJM, Bus SA. Diabetic Foot Ulcers: A Review. JAMA. 2023 Jul 3;3 Wijnand JGJ, Zarkowsky D, Wu B, van Haelst STW, Vonken EPA, Sorrentino TA, Pallister Z, Chung J, Mills JL, Teraa M, Verhaar MC, de Borst GJ, Conte MS. The Global Limb Anatomic Staging System (GLASS) for CLTI: Improving Inter-Observer Agreement. J Clin Med. 2021 Aug 4;10(16):3454.
  4. van Haelst STW, Teraa M, Moll FL, de Borst GJ, Verhaar MC, Conte MS. Prognostic value of the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification in patients with no-option chronic limb-threatening ischemia. J Vasc Surg. 2018 Oct;68(4):1104-1113.e1. doi: 10.1016/j.jvs.2018.02.028. Epub 2018 May 22. PMID: 29802042.
  5. Leithead C, Novak Z, Spangler E, Passman MA, Witcher A, Patterson MA, Beck AW, Pearce BJ. Importance of postprocedural Wound, Ischemia, and foot Infection (WIfI) restaging in predicting limb salvage. J Vasc Surg. 2018 Feb;67(2):498-505.
  6. Bontinis V, Bontinis A, Koutsoumpelis A, Giannopoulos A, Ktenidis K. A systematic review and meta-analysis of GLASS staging system in the endovascular treatment of chronic limb-threatening ischemia. J Vasc Surg. 2023 Mar;77(3):957-963.e3.
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