Critical Limb Ischaemia (CLI) Assessment
Applies the Global Vascular Guidelines (2019) definition of chronic limb-threatening ischaemia (CLTI) and separates acute limb ischaemia (symptoms for 2 weeks or less). Guides urgency of vascular referral.
Score interpretation
No ischaemic rest pain or tissue loss — claudication or asymptomatic PAD (stage with Rutherford / Fontaine).
→ Best medical therapy and a supervised exercise programme for claudication (NICE CG147); safety-net advice for rest pain, ulcers or sudden worsening.
Rest pain with ankle pressure ≥ 50 mmHg: CLTI needs at least one abnormal measure — ankle pressure < 50 mmHg, toe pressure < 30 mmHg, ABI < 0.4, TcPO2 < 30 mmHg or flat pulse volume recordings (Global Vascular Guidelines 2019).
→ Measure toe pressure / TcPO2 (calcified arteries can give a falsely high ankle pressure); urgent vascular referral if confirmed; consider other causes of foot pain.
PAD with ischaemic rest pain (ankle pressure < 50 mmHg) or tissue loss — gangrene, or an ulcer of ≥ 2 weeks with objective PAD (WIfI ischaemia grade ≥ 1) (Global Vascular Guidelines 2019).
→ Urgent vascular surgery referral; stage with WIfI; duplex / CTA to plan revascularisation; best medical therapy (antiplatelet, statin, smoking cessation); wound care and offloading; analgesia; limb salvage MDT.
Symptoms for 2 weeks or less: acute limb ischaemia, not CLTI (Global Vascular Guidelines 2019; ESVS 2020).
→ Emergency vascular surgery referral; unfractionated heparin unless contraindicated; urgent imaging and revascularisation (embolectomy, thrombolysis or bypass) according to the Rutherford acute ischaemia category — an immediately threatened limb needs emergency revascularisation.
Interpretation bands for the Critical Limb Ischaemia. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Methoxyflurane · Inhaled Analgesic — Acute Pain
- Fentanyl Transdermal Patch (Elderly Chronic Pain) · Opioid Analgesic — Transdermal Patch
- Morphine Slow-Release (Elderly Chronic Pain) · Opioid Analgesic — Modified-Release Oral
- Amitriptyline (Neuropathic Pain / Migraine) · Tricyclic Antidepressant / Neuropathic Pain Agent
- Gabapentin · Alpha-2-Delta Ligand — Neuropathic Pain / Epilepsy Adjunct
- Diclofenac (Dysmenorrhoea / Post-gynaecological Procedure) · NSAID — Gynaecological Pain
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.