The Critical Limb Ischemia (CLI) Global Society's mission is to improve quality of life by preventing amputations and death due to CLI.

Propensity Score–Adjusted Comparison of Long-Term Outcomes Among Revascularization Strategies for Critical Limb Ischemia

Jihad A. Mustapha, Barry T. Katzen, Richard F. Neville, Robert A. Lookstein, Thomas Zeller, Larry E. Miller, Teresa R. Nelson, Michael R. Jaff, 

On behalf of the Board of the CLI Global Society

Originally published 9 Sep 2019 Circulation: Cardiovascular Interventions. 2019;12



Few studies have compared long-term outcomes among specific treatment modalities for critical limb ischemia. The aim of this study was to compare long-term outcomes with percutaneous transluminal angioplasty (PTA), stent placement, atherectomy, or surgical bypass in patients diagnosed with critical limb ischemia.

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Critical Limb Ischemia: A Threat to Life and Limb

CLI is an underdiagnosed and undertreated deadly disease that requires proper diagnostic imaging and increased awareness.

Originally published May 2019

Jihad A. Mustapha, MD; Barry T. Katzen, MD; Richard F. Neville, MD, FACS; Robert A. Lookstein, MD; Thomas Zeller, MD, PhD;
Larry E. Miller, PhD; Vickie R. Driver, DPM; and Michael R. Jaff, DO

Peripheral artery disease (PAD) of the lower extremities is a global pandemic of growing proportions. Between 2000 and 2010, the world’s population increased by 12.6%, and the prevalence of PAD has increased twice as much over this period.1 The Global Burden of Disease study reported that 202 million adults worldwide have PAD, a higher prevalence than ischemic heart disease (154 million), heart failure (64 million), Alzheimer’s disease/dementia (44 million), cancer (43 million), HIV/AIDS (36 million), and opioid addiction (27 million).2 Although most patients with PAD are asymptomatic, the disease increases the risk for cardiovascular morbidity and symptomatic disease progression. Patient prognosis after PAD diagnosis is poor because the disease often progresses to the extent that distal perfusion is insufficient to meet metabolic demands. This advanced PAD is commonly described as critical limb ischemia (CLI) and represents the end stage of the disease, mostly characterized by occlusive disease of the tibial and foot arteries in which patients suffer from rest pain, ischemic ulceration, and/or gangrenous tissue loss.

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Determinants of Long-Term Outcomes and Costs in the Management of Critical Limb Ischemia: A Population-Based Cohort Study.

Mustapha JA1, Katzen BT2, Neville RF3, Lookstein RA4, Zeller T5, Miller LE6, Jaff MR7

J Am Heart Assoc.2018Aug21;7(16)

Findings from Recent Study by the CLI Global Society:
  • CLI is a serious problem that threatens both life and limb. Patients with CLI suffer poor long-term prognosis and generate high healthcare costs.
  • Revascularization and attempts to salvage the limb are effective in saving both limbs and reducing mortality.
  • Considerable efforts are needed to raise disease awareness and implement coding to better define and identify the disease.

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Worth an Arm and a Leg: The Critical Importance of Limb Ischemia 
Originally published 15 Aug 2018 Journal of the American Heart Association. 2018;7:e010093

 The CLI Global Society has done expansive work leading up to this publication and have intention of moving forward in obtaining recognition of CLI in the United States as a disease via a CLI-specific DRG designation.  We are engaging the government payer system to enact reform to improve care of patients suffering from this devastating disease.

Author information

1 Advanced Cardiac & Vascular Amputation Prevention Centers Grand Rapids MI.
2 Division of Interventional Radiology Miami Cardiac and Vascular Institute Miami FL.
3 Division of Vascular Surgery Department of Surgery Inova Heart and Vascular Institute Inova Fairfax Medical Campus Falls Church VA.
4 Department of Radiology Icahn School of Medicine at Mount Sinai New York NY.
5 Department of Angiology Universitäts-Herzzentrum Freiburg-Bad Krozingen Bad Krozingen Germany.
6 Miller Scientific Consulting Asheville NC.
7 Newton-Wellesley Hospital Newton MA.

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