Guidelines for Critical Limb Ischaemia and Diabetic Foot – Introduction

Abstract

The European Society for Vascular Surgery appoints Guidelines Committees to write clinical practice guidelines for vascular surgery. Guidelines for the care of patients with critical limb ischaemia accompany this commentary. Guideline development was recommended in 1990 by the Institute of Medicine, to improve decision-making for specific patient circumstances, and to decrease the variability between healthcare providers.1,2 Appropriate decision-making is critical to achieving excellent outcomes. Guidelines have become more popular in surgery and medicine. This probably results from increased attention to evidence-based medicine, the desire for reproducibility in the choice of treatment for a specific patient, increasing government legislation, the need to satisfy insurance regulations, and legal pressures. Critical limb ischaemia (CLI) is a complex condition and there is significant variability in clinical practice, although a valid evidence base is available to guide recommendations. The significant increase in the volume of scientific literature concerning critical limb ischaemia published in recent years along with the number of technical and medical advances supports guideline recommendations with more certainty than before. Potential increases in healthcare costs and risks due to industry and the public-driven use of novel treatments, makes the current guidelines increasingly important.3––6 Many clinical situations of patients with critical limb ischaemia have not been the subject of randomised clinical trials. Patient care, however, needs to be delivered and decisions have to be made in these situations. Therefore, this document should also provide guidance for decisions where extensive Level 1 evidence is not available, and recommendations are determined on the basis of the currently available best evidence. By providing information about the relevance and quality of evidence, this document will enable the reader to locate the most important and evidence-based information relevant to the individual patient.7 To optimise the implementation of the current guideline document, its length has been kept as short as possible to enable easy access to its information. This document is supposed to be a guide, not a set of rules, and allows flexibility for specific patient circumstances.