Urgent need to clarify the definition of chronic critical limb ischemia – a position paper from the european society for vascular medicine

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Summary: Chronic critical lower limb ischemia (CLI) has been defined as ischemia that endangers the leg. An attempt was made to give a precise definition of CLI, based on clinical and hemodynamic data (Second European Consensus). CLI may be easily defined from a clinical point of view as rest pain of the distal foot or gangrene or ulceration. It is probably useful to add leg ulcers of other origin which do not heal because of severe ischemia, and to consider the impact of frailty on adverse outcome. From a hemodynamic viewpoint there is no consensus and most of the existing classifications are not based upon evidence. We should thus propose a definition and then validate it in a prospective cohort in order to define the patients at major risk of amputation, and also to define the categories of patients whose prognosis is improved by revascularisation. From to-day’s available data, it seems clear that the patients with a systolic toe pressure (STP) below 30 mmHg must be revascular-ised whenever possible. However other patients with clinically suspected CLI and STP above 30 mmHg must be evaluated and treated in specialised vascular units and revascularisation has to be discussed on a case by case basis, taking into account other data such as the WiFi classification for ulcers.In conclusion, many useful but at times contradictory definitions of CLI have been suggested. Only a few have taken into account evidence, and none have been validated prospectively. This paper aims to address this and to give notice that a CLI registry within Europe will be set up to prospectively validate, or not, the previous and suggested definitions of CLI.


  • Joël Constans
  • Alessandra Bura-Rivière
  • Adriana Visona
  • Marianne Brodmann
  • Pierre Abraham
  • Dan Mircea Olinic
  • Juraj Madaric
  • Sabine Steiner
  • Isabelle Quéré
  • Lucia Mazzolai
  • Jill Belch
  • Anders Gottsäter (Medarbetare)
  • ESVM
Externa organisationer
  • Hopital St Andre, Bordeaux
  • University of Bordeaux
  • Rangueil Hospital
  • Azienda ULSS 2
  • Medical University of Graz
  • CHU Angers
  • Institut Gustave Roussy
  • University of Medicine and Pharmacy, Cluj-Napoca
  • National Institute of Cardiovascular Diseases Slovakia
  • Leipzig University
  • Hôpital Saint Eloi
  • Kantonsspital Frauenfeld
  • Lausanne University Hospital
  • University of Dundee
  • Skåne University Hospital

Ämnesklassifikation (UKÄ) – OBLIGATORISK

  • Kardiologi


Sidor (från-till)223-227
TidskriftVasa - European Journal of Vascular Medicine
Utgåva nummer3
StatusPublished - 2019
Peer review utfördJa
Externt publiceradJa