This protocol applies to patients with Leriche syndrome who have progressed to chronic limb-threatening ischemia (CLTI): worsening claudication accompanied by nonhealing ischemic ulcers on the digits of the feet. Nonhealing wounds mark a transition beyond intermittent claudication and indicate that limb viability is at immediate risk.
Worsening claudication and small ischemic ulcers on the digits of both feet confirm the progression from intermittent claudication to CLTI. Patients with nonhealing wounds in this setting require restoration of adequate perfusion to the foot to prevent further tissue loss and amputation.
Management combines antiplatelet therapy as an adjunct with revascularization strategies to restore in-line blood flow to the foot — the specific options and full algorithm are covered in the structured protocol.
Worsening claudication and small ischemic ulcers on digits of both feet.
Patients with nonhealing wounds have progressed from IC to CLTI.
Single-agent antiplatelet therapy is recommended in all symptomatic patients with PAD to reduce the risk of MACE and CV mortality.
An endovascular approach with percutaneous stent placement and restoration of inline flow to the foot with treatment of the superficial femoral artery disease is appropriate because CLTI is rarely isolated to the aortoiliac segment alone.
Restoration of flow to promote healing of the digital wounds is recommended and can also be achieved by surgical revascularization options such as aortofemoral bypass or hybrid revascularization procedures using a multidisciplinary approach (such as endovascular treatment of the aortoiliac occlusive disease and surgical infrainguinal bypass to address the femoropopliteal segment).
The 2016 AHA/ACC guidelines recommend EVR to establish in-line blood flow to the foot in patients with nonhealing wounds (class IB).
The goal of treatment is adequate wound healing to limit the risk of amputation.
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