Citations 1
Development of a standard definition of ‘no-option’ and ‘poor-option’ for revascularization in chronic limb-threatening ischemia
Fabiani, Mario Alejandro , Berg, Jos C van den, Torre, Oscar A De la, Verastegui, Alfredo , Dua, Anahita, Alexandrescu, Vlad Adrian, Baadh, Amanjit S. , Bahaa, Nasr, Carvajal, Juan Guillermo Barrera, Beasley, Robert , Bisdas, Theodosios, Blessing, Erwin , Bonvini, Stefano, Brodmann, Marianne, Cabral, Gonçalo, Cancellieri, Roberto, Casini, Andrea , Chandra, Venita , Chisci, Emiliano, Chohan, Omar, Choke, Edward, Chong, Patrick, Clerici, Giacomo , Coscas, Raphaël, Costantino, Del Giudice, D'Oria, Mario, Davies, Robert, Donato, Gianmarco de , Vries, Jean-Paul de , Río-Solá, M.L. del, Deloose, Koen , Dhand, Sabeen , Díaz-Sandoval, Larry J, Falcone, Gianmarco , Fanelli, Fabrizio , Cardona, Lucas Ferrer, Garg, Karan, Giuffrida, Stefania, Gouëffic, Yann, Goverde, Peter , Henao, Esteban, Vegas, Diego Jorge Herrera, Hinchliffe, Robert, Hoballah, Jamal J. , Howard, Dominic, Huasen, Bella , Iida, Osamu, Katsanos, Konstantinos, Kolh, Philippe, Korosoglou, Grigorios, Lecis, Alexandre, Leopoldo, Marine, Lessne, Mark L. , Lichtenberg, Michael, Lobato, Marta , Loreni, Giorgio, Madassery, Kumar, Manzi, Marco, Maene, Lieven, Maresch, Martin, Trabal, Jorge Martinez, Mathews, S Jay, Michael, Siah, J, Bosiers Michel, Migliara, Bruno , Mills, Joseph, Miserlis, Dimitrios , Montero-Baker, Miguel, Alvarez, Luis Morelli, Morgan, Robert Anthony, Mouawad, Nicolas, Moxey, Paul, Antonio, Jose, Nakama, Tatsuya , Neville, Richard, Noronen, Katariina , Palena, Mariano, Parikh, Sahil, Parlani, Gianbattista, Pasqui, Edoardo , Patel, Rafiuddin, Patel, Ashish, Perkov, Dražen , Portou, Mark James, Langhoff, Ralf , Reijnen, Michel Marinus Petrus Johannes, Roy, Trisha , Ruffino, Maria Antonella , Gúzman, Tania Sáez, Sakr, Ahmed, Santini-Domínguez, Rafael , Schmidt, Andrej, Schneider, Peter, Sheorain, Virendersingh K, Siracuse, Jeffrey, Sirvent, Marc , Sommerset, Jill , Spiliopoulos, Stavros, Spinelli, Alessio , Stavroulakis, Konstantinos, Taneva, Gergana T, Teso, Desarom , Thomas, Shannon, Torsello, Giovanni, Tummala, Venkat, Tummala, Srinivas, Twine, Christopher, Uberoi, Raman, Heuvel, Daniel Van den, Varcoe, Ramon Lee, Serrano, José Francisco Vargas, Céniga, Melina Vega de, Venermo, Maarit, Vijaynagar, Badri, Stempel, Conrad von , Voûte, Michiel Thomas, Watts, Mine, Zaefferer, Patricio, Zayed, Hany , Zeebregts, Clark J, Zola, N'Dandu, Mills, Joseph L. , Torre, O. , Verastegui, Alfredo , de la Torre, Oscar , Fabiani, Mario Alejandro , Berg, Jos C. van den , Dua, Anahita , Nasr, Bahaa , Biasi, Lukla , Bisdas, Theodosios , Brodmann, Marianne , Cabral, Gonçalo , Caradu, Caroline , Casini, Andrea , Chisci, Emiliano , Choke, E, Chong, Patrick L.E., Cioppa, Angelo , Coscas, Raphaël , Giudice, Costantino Del , D'Oria, Mario , Peruyera, Pablo Del Canto , Διαμαντόπουλος, Αθανάσιος , Díaz‐Sandoval, Larry J. , Dick, Florian , Fazzini, Stefano , Ferrer, Lucas M. , Fujihara, Masahiko , Garg, Karan , Garriboli, Luca , Genovese, Elizabeth A. , Gifford, Edward D. , Gouëffic, Yann , Gupta, Prem Chand , Vegas, Diego Herrera , Hinchliffe, Robert J. , Holden, Andrew Hugh , Isernia, Giacomo , Kolh, Philippe H. , Korosoglou, Grigorios , Krokidis, Miltiadis E. , Lichtenberg, Michael, Loureiro, Luís , Mathews, S. Jay , Bosiers, Michel Joseph , Morosetti, Daniele , Mouawad, Nicolas J. , Moxey, Paul, Neville, Richard, Palena, Luis Mariano , Parikh, Sahil, Parlani, Gianbattista, Patel, Rafiuddin, Patrone, Lorenzo , Portou, Mark J. , Pratesi, Giovanni , Rammos, Christos , Reijnen, Michel M.P.J. , Sakr, Ahmed , Schneider, Peter A. , Secemsky, Eric A. , Sheorain, Virendersingh K, Simonte, Gioele , Spiliοpoulos, Stavros , Stavroulakis, Konstantinos , Steiner, Sabine , Taneva, Gergana T. , Torsello, Giovanni , Troisi, Nicola , Twine, Christopher P. , Uberoi, Raman , Ucci, Alessandro , Heuvel, Daniel van den, Varcoe, Ramon Lee , Venermo, Maarit A. , Voûte, Michiel T., Ysa, August , Zeebregts, Clark J. , Zeller, Thomas , N'Dandu, Zola M.
British Journal of Surgery | April 3, 2026 | Volume: 113 | Issue: 4 | Pages: No page available
Abstract Introduction Revascularization to prevent limb loss is not feasible or represents a very high risk in a significant proportion of patients with chronic limb-threatening ischaemia (CLTI). No standard definition currently exists to define this population of patients. The aim of this study was to develop a consensus-based, multidomain definition to improve clinical assessment and reporting of studies in people with ‘no option’ (NO) or ‘poor option’ (PO) CLTI. Methods A modified Delphi process was conducted with 164 specialists from 30 countries. Two iterative survey rounds were used to reach consensus, defined as ≥70% agreement with a score of ≥7 on a nine-point scale. Results Some 164 international vascular specialists participated in the study, averaging 19 years of experience. A multidomain framework including arterial disease anatomy, biology, risk, function, and context (ABRFC) achieved 83% consensus. A ‘desert foot’ was defined as the absence of distal arterial revascularization targets on advanced non-invasive imaging, invasive digital subtraction angiography, and at least one failed endovascular revascularization attempt (81.6% agreement). Inadequate autogenous bypass conduit was defined as the lack of usable autologous vein across all four limbs (85% agreement). Patients were classified as NO for revascularization if they present with ‘desert foot’, prohibitive medical risk, a non-functional limb, or in those patients who refused arterial revascularization. PO revascularization patients combined factors such as severe infection, lack of autologous vein, or treatment non-compliance (72.1% agreement). Conclusion This consensus study established a structured, expert-validated definition of no option or poor option for revascularisation of patients with CLTI. The multidomain ABRFC framework provides a foundation for standardized clinical assessment, trial design, and future guideline development.