Abstract
As most patients recently diagnosed with critical limb ischemia（CLI）have diabetes mellitus, it is necessary to understand the pathophysiology of ulceration and properly select treatment modalities. If the vascular lesions in CLI are mainly due to diseases of lower extremity arteries and if bypass surgery is feasible using a vein graft（diameter: 3.5 mm or more）in good vascular conditions, surgical revascularization may be a good treatment choice, as it is expected to maintain adequate blood flow and long-term patency of the bypass graft. On the other hand, for the high-risk patients with systemic arterial sclerosis, it is important to set a treatment goal properly and select endovascular therapy（EVT）or surgical revascularization carefully. The SPINACH study, a recently reported study from Japan, recommended surgical reconstruction even for patients with major tissue damage, including wound, ischemia, and foot infection（WIfI）classification W-3 or fI2-3, and/or history of minor foot amputation. As an overall treatment strategy covering numerous systemic conditions and local lesions has not been established yet, construction of a new treatment strategy is desired employing recent advances in evaluation methods, such as the WIfI classification system, and by disseminating common knowledge among different departments and professions.
