Structured Decision-Making in the CLTI Patient: Understanding the PLAN (Patient risk, Limb severity, ANatomic complexity)

This session will help expand physicians’ knowledge base and improve clinical confidence and effectiveness in treating patients with CLTI.

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• Moderators & Faculty
• Learning Objectives
• Description
• Schedule
• Recommended Reading 

Moderators and Faculty

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	Joseph L. Mills, MD, FACS Professor and Chief, Division of Vascular & Endovascular Therapy Michael E. DeBakey Department of Surgery  Baylor College of Medicine
Misty D. Humphries, MD, MAS, RPVI Associate Professor of Surgery; Interim Chief, Division of Vascular Surgery UC Davis	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, MD  Associate Professor of Surgery  University of California San Francisco-Fresno	Christopher Abularrage, MD The Bertram M. Bernheim Professor of Surgery & Fellowship Program Director Vascular & Endovascular Therapy Johns Hopkins University

Learning Objectives

• Review the PLAN (Patient risk, Limb severity, ANatomic complexity of disease) algorithm to aid in shared, patient-centered decision-making for chronic limb-threatening ischemia (CLTI).
• Describe the use of the Vascular Quality Initiative (VQI) CLTI calculator to estimate procedural risk and long-term survival.
• Review WIfI (wound, ischemia, foot infection) staging to estimate the risk of amputation and the benefit of revascularization.
• Demonstrate examples of the use of Society for Vascular Surgery WIfI and GLASS (Global Limb Anatomic Staging System) calculators in specific patients.

Description

This session will help expand physicians’ knowledge base and improve clinical confidence and effectiveness in treating patients with CLTI. The focus of this webinar will be to review the patient PLAN algorithm based on the Global Vascular Guidelines in CLTI. The importance of staging to guide the course of treatment and potential alterations in the treatment plan will be reviewed. The use of the VQI, WIfI, and GLASS applications to facilitate evidence-based decision-making for CLTI patients will be reviewed.

Case presentations will illustrate how to practically use the PLAN approach in specific clinical scenarios. A short survey will be conducted before and after the session, and a follow-up survey will be conducted in 90 days.  

Schedule

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.