Informed Decision-Making in CLTI with Patients Pre-Questions

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* 1. Name

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* 2. Email

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* 3. Which of the following classification systems do you use currently for staging your CLTI patients? (check all that apply)

VQI CLTI mortality prediction model

WIfI

GLASS

Rutherford

Other

Do not stage, treat all with suspicion of CLTI the same way

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* 4. How confident are you using the classification/staging systems?

Very confident

Confident

Somewhat confident

Not confident

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* 5. Do you currently practice shared decision-making with your CLTI patients in the development of their treatment plan? (Including patient-centered goals, discussion of all options).

Always

Often

Sometimes

Rarely

Never

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* 6. Do you routinely integrate the PLAN approach (patient risk, limb severity, anatomic complexity) with your CLTI patients in everyday practice?

Always

Often

Sometimes

Rarely

Never

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* 7. During treatment of CLTI do you restage your patients if their symptoms have not resolved following an initial strategy?

Always

Often

Sometimes

Rarely

Never

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* 8. Do you discuss and offer both open and endo options for your CLTI patients who appear to be acceptable surgical candidates?

Always

Often

Sometimes

Rarely

Never

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* 9. Do you perform vein mapping in your CLTI patients who are acceptable surgical candidates, as part of a standard work up to outline their treatment options?

Always

Often

Sometimes

Rarely

Never

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* 10. Do you discuss prognosis based on presenting limb stage (WIfI) with your CLTI patients?

Always

Often

Sometimes

Rarely

Never

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* 11. Do you make decisions on urgency of revascularization based on WIfI staging?

Always

Often

Sometimes

Rarely

Never

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* 12. Do you make decisions on need for hospitalization based on WIfI staging?

Always

Often

Sometimes

Rarely

Never

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* 13. In making recommendations about revascularization approach for your CLTI patients, do you:

Customize the recommendation based on the PLAN framework

Prioritize the approach based on ease of access to the required facilities or staff

Always recommend an endovascular intervention first

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* 14. Do you incorporate a multidisciplinary team (i.e. routine involvement of specialist(s) from podiatry, cardiology, vascular medicine, radiology, others) in the care of your patients with CLTI?

Only for selected patients

Routinely

Rarely

Never/not available in my everyday practice

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* 15. A 69 yo black female with type 2 diabetes presents with 2 weeks history of evolving gangrene of the left hallux to the level of the MTP joint, mild cellulitis, and rest pain. She has been generally active until very recently, no known CAD or CVD, stage 2 CKD. She takes metformin, atorvastatin, lisinopril, and aspirin. Femoral pulses are 2+ bilaterally; popliteal and pedal pulses not palpable. The left ABI is 0.5 and toe pressure measured at the second digit is 18 mm Hg with minimal pulsatility.

Based on the information provided, the most likely patient risk and limb stage severity for this patient is:

Average patient risk, high limb threat severity (WIfI 4)

High patient risk, high limb threat severity (WIfI 4)

Average patient risk, moderate limb threat severity (WIfI 3)

High patient risk, moderate limb threat severity (WIfI 3)

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* 16. A selective left leg angiogram is performed, revealing occlusion of the distal SFA at the adductor canal, diffuse and severe popliteal disease, occlusion of tibioperoneal trunk, reconstitution of the peroneal artery in the upper calf which then reconstitutes the distal anterior tibial in the lower third of the leg, with intact dorsalis pedis into the foot. The posterior tibial is not visualized. In using the GLASS system to estimate anatomic complexity of disease, which of the following are true:

The preferred target artery path (TAP) should be the anterior tibial artery

The preferred target artery path (TAP) should be the peroneal artery

Regardless of the selected TAP, the GLASS stage is 3 (high complexity) due to the severity of the popliteal and trifurcation disease

Expected technical failure rate for endovascular is <10%