Critical Limb Threatening Ischemia (CLTI) represents the terminal stage of peripheral arterial disease (PAD). Over a 5-year period, 5% to 10% of patients with either mild to moderate PAD (as manifested by symptoms of intermittent claudication) will progress to CLTI. This clinical deterioration has been associated with multiple factors, including the frantic worldwide epidemic of obesity and diabetes, as well as the aging population, and the failed attempts at controlling tobacco use; and its prevalence is expected to exponentially increase to a conservatively estimated 2.8 million patients by 2020. The contemporary management of patients with CLTI is complex due to the multifaceted nature inherent to the disease process and the multiple gaps in care that are typical of currently common practice workflows, whereby different specialists treat the patient in an isolated, uncoordinated (and therefore inefficient) fashion. Each expert takes care of “one aspect” of the patient, but everyone misses the big picture represented by the need of a simultaneous, transition less and efficient multidisciplinary approach. This article intends to illustrate what the multidisciplinary approach to the management of patients with CLTI should look like in 2019.
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