The method of revascularization in CLI has created controversy due to the absence of sufficient trial data. Only one randomized controlled trial (BASIL) has been published to help guide revascularization choice. BASIL indicated that endovascular revascularization was comparable to surgical revascularization, in terms of amputation-free survival—the primary endpoint. The technology used in the endovascular arm was balloon angioplasty alone, archaic by today’s standards. Multiple randomized trials of surgical versus endovascular revascularization are ongoing, which will help to guide this discussion. Until that time, proposed algorithms as seen in Figure 4 provide a framework for approaching CLI.
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