A new publication from our multinational BEST-CLI collaboration, now in the Journal of Vascular Surgery, underscores a simple but powerful truth: patients with chronic limb-threatening ischemia (CLTI) do better when they are treated by a team.
Why This Matters
CLTI is the most advanced form of peripheral artery disease, often affecting people with diabetes and multiple comorbidities. It is not only a vascular problem but also a wound, infection, and mobility problem. Addressing all of these requires coordination across specialties—vascular surgeons, interventionalists, podiatrists, wound care providers, and others.
The BEST-CLI trial, the largest randomized study of surgical versus endovascular therapy for CLTI, provided a unique opportunity to ask whether having a formally defined multidisciplinary team at a trial site changed outcomes.
What We Found
Across 110 centers representing over 1,500 patients, only about one-third reported a dedicated limb preservation team. Yet those centers had:
- Fewer major amputations – Patients treated at team-based centers were 40% less likely to undergo an above-ankle amputation compared with those at centers without a team (hazard ratio 0.60, p = .005) .
- Stronger podiatry and wound care involvement – Podiatrists were primary caregivers at 32% of team sites versus only 11% at non-team sites; wound specialists likewise had a greater role .
- Lower high–low amputation ratios – More minor, limb-sparing amputations and fewer major amputations (0.20 vs 0.31), reflecting a “toe-and-flow” model of coordinated care .
- Better communication – 71% of respondents at team sites rated collaboration as “highly effective” compared with 29% at sites without teams .
Implications for Practice
This work confirms what many in the limb-preservation community have long advocated: multidisciplinary CLTI teams save limbs. Importantly, the data come not from single-center observational reports but from the rigor of an international randomized trial environment.
While the exact composition of teams varied—reflecting local expertise and resources—the consistent thread was communication and the integration of podiatry and wound care alongside revascularization.
Looking Ahead
Establishing and sustaining CLTI teams takes resources and coordination, but the payoff is clear: more patients keeping their legs, more functional mobility preserved, and more lives improved.
The BEST-CLI experience provides evidence that can inform guidelines, health system planning, and future trials. Just as oncology has long relied on tumor boards, the time has come for every hospital caring for CLTI to establish a limb preservation board.
Full citation:
Jones DW, Farber A, Armstrong DG, Azene E, Duncan A, Todoran TM, Doros G, Strong MB, Rosenfield K, Conte MS, Menard MT. “Characteristics of multidisciplinary limb preservation teams and their impact on outcomes in the BEST-CLI trial.” J Vasc Surg. 2025; 1–11. doi:10.1016/j.jvs.2025.08.028
Leave a Reply