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The scenario details her medical history, including well-controlled cardiac risk factors, prior vascular interventions, and current medications. Examination reveals absent pulses below the left popliteal artery and a positive Buerger's test, with no current ulceration. The tutorial aims to cover international guidelines on CLTI classification, the role of various imaging modalities, indications for treatment, and a comparison of management options including pharmacological, endovascular, and open surgical approaches. It highlights the prevalence of CLTI, its progression from claudication, and the significant risks of amputation and mortality associated with both untreated and treated disease, citing the Rutherford, TASC II, and SVS WIfI classification systems. The document is structured to facilitate learning objectives for vascular surgery trainees, emphasizing the critical nature of CLTI and the need for comprehensive assessment and management strategies.",{"@graph":69,"@context":122},[70,84,105],{"@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/lower-limb-peripheral-artery-disease-vascular-tutorial-set-1-and-2/265949/",{"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/lower-limb-peripheral-artery-disease-vascular-tutorial-set-1-and-2/265949.png","ImageObject",300,407,{"name":92,"@type":93},"Lucas Martin","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-14",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What are the key learning objectives of this vascular tutorial?","Question",{"text":112,"@type":113},"The learning objectives include discussing current international guidelines on chronic limb-threatening ischemia (CLTI) and its classification, the role of different imaging modalities, indications for treatment in CLTI, and comparing management options such as pharmacological, endovascular, and open surgery.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What is the clinical scenario presented in this tutorial?",{"text":117,"@type":113},"The tutorial presents a case of a 92-year-old female with two months of nocturnal rest pain in her left foot, absent pulses below the left popliteal artery, and a positive Buerger's test, with a history of prior vascular interventions.",{"name":119,"@type":110,"acceptedAnswer":120},"What is the significance of Chronic Limb-Threatening Ischemia (CLTI)?",{"text":121,"@type":113},"CLTI is a broad group with varying degrees of ischemia that may delay wound healing and increase amputation risk. It affects approximately 1% of the population, and untreated CLTI carries a significant risk of amputation (22%) and mortality within 12 months.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},265949,1789402758,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"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":129,"read_time":144},8796095360427,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Lower Limb Peripheral Artery Disease  \nVascular Tutorial (SET 1 and 2)  \n30 March 2020  \nClinical Scenario 2  \n• A 92 yo lady describes two months of consistent nocturnal rest pain, relieved by standing, in her left foot. She has had a previous tibial angioplasty and SFA stenting for rest pain about 4 years ago .  \n• Background includes: Well controlled cardiac risk factors (HT, hypercholesterolaemia), prior PTCA for IHD, AF, PPM.  \n• Medications: Dabigatran, Atorvastatin, Ranitidine, Perindopril, PanadolOsteo, Targin 5/2.5mg  \n• On clinical examination she has absent pulses below the left poplitealand is Buergers test positive . No evidence of tissue ulceration is present.  \nImaging 2  \nLearning Objectives 2  \n1. Discuss current international guidelines on chronic limb-threatening ischaemia (CLTI) including classification methods .  \n2. Discuss the role of different imaging modalities in this scenario.  \n3. Describe the indications for treatment in CLTI.  \n4. Compare management options in this scenario including pharmacological, endovascular and open surgery.  \nChronic limb-threatening ischaemia  \n• Broad group with varying degrees of ischemia that may delay wound healing and increase amputation risk  \n• Prevalence ~1% of population  \n• Progression from claudication to CLTI (Sigvant 2016)  \n• Over 5 years 21%  \n• Amputations in 4-27%  \n• Untreated natural history over 12 months (Abu Dabrh AM 2015)  \n• 22% amputation rate and mortality  \n• Treated amputation rates still high  \n• 12% at 6 months and up to 50% at 4 years  \n• Mortality risk similar – up to 50% at 4 years  \nClassification systems for CLTI  \n\n| System | Issues |\n| --- | --- |\n| Rutherford 1997 | Relies on CLI cut-off values |\n| TASC II 2007 + 2015 | Focussed on anatomy rather than limb signs |\n| SVS WIfI 2014 | ?complex |\n\nRutherford  \nTASC II","cbCaimgD34C4qUBt","https://ap.wps.com/l/cbCaimgD34C4qUBt","pdf",1274072,25,"English","# Lower Limb Peripheral Artery Disease\n# Vascular Tutorial (SET 1 and 2)","[{\"question\":\"What are the key learning objectives of this vascular tutorial?\",\"answer\":\"The learning objectives include discussing current international guidelines on chronic limb-threatening ischemia (CLTI) and its classification, the role of different imaging modalities, indications for treatment in CLTI, and comparing management options such as pharmacological, endovascular, and open surgery.\"},{\"question\":\"What is the clinical scenario presented in this tutorial?\",\"answer\":\"The tutorial presents a case of a 92-year-old female with two months of nocturnal rest pain in her left foot, absent pulses below the left popliteal artery, and a positive Buerger's test, with a history of prior vascular interventions.\"},{\"question\":\"What is the significance of Chronic Limb-Threatening Ischemia (CLTI)?\",\"answer\":\"CLTI is a broad group with varying degrees of ischemia that may delay wound healing and increase amputation risk. It affects approximately 1% of the population, and untreated CLTI carries a significant risk of amputation (22%) and mortality within 12 months.\"}]","Lower Limb Peripheral Artery Disease - Vascular Tutorial (SET 1 and 2) | PDF",63]