Limb Anatomic Capital Across the Claudication-to-Chronic Limb-Threatening Ischemia Trajectory: A Scoping Review and Framework for Longitudinal Revascularization Stewardship.

Authors

Jeffrey H Shuhaiber

Published in

Journal of vascular and interventional radiology : JVIR. Pages 109092. Sep 19, 2026. Epub Sep 19, 2026.

Abstract

To explore whether claudication-stage management may affect native arterial substrate available for later revascularization options and propose a longitudinal stewardship framework.
A PRISMA-ScR review searched PubMed/MEDLINE across four domains: prior intervention and bypass outcomes, tibial runoff, procedural burden and conservative management, and no-option chronic limb-threatening ischemia (CLTI).
Twenty-eight studies and guidelines were included. Prior ipsilateral endovascular intervention was associated in one study with higher 1-year major amputation (31% vs 20%) and graft occlusion (28% vs 18%). Three-year primary patency was 35.8% with absent tibial outflow versus 60.9% with intact runoff. Complete optimal medical therapy was documented in 38.1% at intervention; supervised exercise completion ranged from 5% to 55%. Approximately 20% of patients with CLTI were reported to lack a conventional revascularization option.
Evidence supports prospective measurement of limb anatomic capital but does not separate natural disease progression from intervention-associated change. Proposed stewardship tools require prospective clinical validation.

PMID:
42763098
Bibliographic data and abstract were imported from PubMed on 20 Sep 2026.

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