[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-265952-105":59,"doc-detail-265952-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","limb-salvage-evidence-based-cli-therapies-2016","Limb Salvage - Evidence-Based CLI Therapies - 2016","","Peripheral artery disease (PAD) remains a rapidly increasing global health problem, with many patients progressing to critical limb ischemia (CLI) only after delayed diagnosis. CLI carries high risks of myocardial infarction, stroke, limb loss, and death, with substantial mortality and major amputation rates within the first year. Treatment patterns in the United States often follow an amputation-first pathway, reflecting underutilization of revascularization. The text reviews the natural history of CLI and evidence supporting endovascular and surgical strategies, including femoropopliteal lesion management and trial data such as BASIL.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/limb-salvage-evidence-based-cli-therapies-2016/265952/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/limb-salvage-evidence-based-cli-therapies-2016/265952.png","ImageObject",300,407,{"name":92,"@type":93},"Ava Thompson","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-14",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is CLI difficult to detect in routine clinical practice?","Question",{"text":113,"@type":114},"Many PAD patients are asymptomatic or lack typical claudication symptoms, delaying diagnosis. Low or delayed detection by healthcare providers contributes to CLI being discovered at advanced stages.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What outcomes make CLI particularly high risk?",{"text":118,"@type":114},"Patients with CLI face significantly increased risk of myocardial infarction, stroke, limb loss, and death. Within one year of diagnosis, about 30% undergo major amputation and 25%–30% die.",{"name":120,"@type":111,"acceptedAnswer":121},"How have evidence-based therapies and trials influenced CLI treatment approaches?",{"text":122,"@type":114},"The text notes a gap between real-world CLI practice and available evidence, with revascularization often underused. Evidence such as the BASIL trial supports comparable amputation-free survival for endovascular therapy versus surgery, while endovascular treatment is described as less morbid and less expensive.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},265952,1789402767,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":130,"read_time":144},1649267921044,"https://us-avatar.wpscdn.com/avatar/1800007509477c92dfb?_k=1786009248482753345","LIMB SALVAGE  \nEvidence-Based CLI Therapies in 2016  \nThe gap between real-world CLI practice and evidence-based therapies remains wide. BY LARRY J . DIAZ-SANDOVAL, MD; J.A . MUSTAPHA, MD; AND FADI SAAB, MD  \nD  \nespite the fact that the statistics highlighting the natural history of peripheral artery disease (PAD) have been commonly understood for nearly a decade, its prevalence continues to  \nincrease at an alarming pace worldwide. Large-scale studies indicate that there will be 22 million patients with PAD by 2030. PAD exerts a deleterious effect on patient morbidity and mortality, with a threefold increase in the risk of cardiovascular death compared to patients without PAD.1-3 Advancing age, male sex, African American race/ethnicity, tobacco abuse, diabetes, dyslipidemia, hypertension, and coronary artery disease are all strongly associated with an increase in the risk of developing PAD. These patients present with a wide variety of symptoms, but only 10% to 20% have typical claudication symptoms, and almost 50% have asymptomatic PAD.4,5 These difficulties have hindered our ability to diagnose PAD and have led to low or delayed detection rates by health care providers,5 unfortunately leading many of these patients (\u003C 10%) to only be discovered when they present with critical limb ischemia (CLI).6  \nNATURAL HISTORY OF CLI  \nThe path that leads to the development of CLI isnot governed by an organized progression through a series of clinical stages, as patients with PAD can be symptomatic or asymptomatic prior to reaching this terminal stage.7 Patients with CLI have a significantly increased risk for myocardial infarction, stroke, limb loss, and death. Within the first year of clinical diagnosis, an estimated 30% of patients with CLI will undergo a major amputation, and 25% to 30% will die.8 When revascularized, these patients require intensive care, complex procedures, surveillance, and the participation of a multidisciplinary team, utilizing resources that could be portrayed as an added strain to a healthcare system that is already under pressure.9 It should  \nbe emphasized that amputations are neither the solution nor the final step for patients with CLI. Instead, the initial amputation is followed by revisions, more proximal amputations, contralateral amputations, and cardiovascular procedures, all of which add to the total economic burden.  \nCLI THERAPIES  \nThe treatment of CLI in the United States has been characterized as a pathway to amputation, as 67% of Medicare patients who underwent a major amputation did not have any other exploratory or therapeutic procedures prior to losing their limb.10 This finding was confirmed in a recent study of 20,464 Medicare patients with CLI who underwent amputations, which revealed that 71% had no revascularization and 54% did not even undergo angiography, underscoring the fact that revascularization procedures (endovascular and surgical) have largely been underutilized.11 This could be ascribed, at least in part, to the paucity of randomized controlled trials (RCTs) comparing both strategies, which have been difficult to implement.12 This represents a clear example of the existing gap between “realworld CLI practices” and the availability of evidencebased therapies. Over the last few years, there has been a significant increase in the amount of CLI-related data. However, these data continue to be applied mainly in the relatively few CLI centers of excellence, perpetuating the mismatch between data availability and day-today CLI practices.  \nFemoropopliteal Segment  \nAtherosclerotic plaque in CLI is omnipresent; however, approximately 65% of the obstructive lesions are located in the femoropopliteal space and exhibit complex features (length and degree of calcification) that qualify most of them as TASC C or D lesions. Endovascular techniques have continued to evolve  \n38 ENDOVASCULAR TODAY MAY 2016 VOL. 15, NO. 5  \nLIMB SALVAGE  \nand have slowly and progressively replaced the once ","cbCaif6Ylqoy3MlX","https://ap.wps.com/l/cbCaif6Ylqoy3MlX","pdf",101620,"English","# Limb Salvage\n## Natural History of CLI\n## CLI Therapies\n## Femoropopliteal Segment","[{\"question\":\"Why is CLI difficult to detect in routine clinical practice?\",\"answer\":\"Many PAD patients are asymptomatic or lack typical claudication symptoms, delaying diagnosis. Low or delayed detection by healthcare providers contributes to CLI being discovered at advanced stages.\"},{\"question\":\"What outcomes make CLI particularly high risk?\",\"answer\":\"Patients with CLI face significantly increased risk of myocardial infarction, stroke, limb loss, and death. Within one year of diagnosis, about 30% undergo major amputation and 25%–30% die.\"},{\"question\":\"How have evidence-based therapies and trials influenced CLI treatment approaches?\",\"answer\":\"The text notes a gap between real-world CLI practice and available evidence, with revascularization often underused. Evidence such as the BASIL trial supports comparable amputation-free survival for endovascular therapy versus surgery, while endovascular treatment is described as less morbid and less expensive.\"}]","Limb Salvage - Evidence-Based CLI Therapies - 2016 | PDF",13]