Back to 2025 Abstracts
Characteristics Of Multidisciplinary Limb Preservation Teams And Their Impact On Outcomes In The BEST-CLI Trial
Douglas W. Jones, MD MS1, Alik Farber, MD MBA
2, David G. Armstrong, MD DPM PhD
3, Ezana Azene, MD PhD
4, Audra Duncan, MD
5, Tom Todoran, MD MS
6, Gheorghe Doros, PhD MBA
7, Michael B. Strong, MA
8, Kenneth Rosenfield, MD
9, Michael S. Conte, MD
10, Matthew T. Menard, MD
8.
1UMass Medical Center, Worcester, MA, USA,
2Boston Medical Center, Boston, MA, USA,
3University of Southern California, Worcester, CA, USA,
4Gundersen Health System, La Crosse, WI, USA,
5Western University, London, ON, Canada,
6Medical University of South Carolina, Charleston, SC, USA,
7Boston University School of Public Health, Boston, MA, USA,
8Brigham and Women's Hospital, Boston, MA, USA,
9Massachusetts General Hospital, Boston, MA, USA,
10University of California, San Francisco, San Francisco, CA, USA.
OBJECTIVES: Multidisciplinary care of chronic limb threatening ischemia (CLTI) through specialized CLTI teams has been associated with improved outcomes, particularly decreased major amputations. Our goal was to characterize CLTI teams and examine their effect on outcomes in the Best Endovascular versus Surgical Therapy in Patients with CLTI (BEST-CLI) trial.
METHODS: Responses from a previously described post-trial electronic survey were used to describe CLTI care providers and characterize centers based on the presence of a “formally defined team dedicated to the care of CLTI patients.” Patient-level data were analyzed to determine the effect of CLTI teams on outcomes. The primary outcomes were: (1) major (above-ankle) amputation, (2) major adverse limb event (MALE) or death from any cause. Cox multivariable models were used to control for patient demographics, limb stage, and revascularization type.
RESULTS: Among survey respondents, specialties identified most frequently as being among those primarily responsible for CLTI care at centers with CLTI teams were: vascular surgery (90%), podiatry (32%) and wound care (22%). Compared with centers without CLTI teams, podiatrists at CLTI team centers were more likely to have a primary role (32% vs 11%) and less likely to be unavailable (4% vs 22%) (P<0.001). Similarly, at centers with CLTI teams, wound care was more likely to have a primary role (22% vs 8%) and less likely to be unavailable (4% vs 11%) (P=0.02). Effectiveness of teamwork among CLTI providers was described as “highly effective” in 71% of respondents with a CLTI team vs 29% without a team (P<0.001). In BEST-CLI, 110 centers (73%) could be classified based on availability of a CLTI team (31% team vs 69% no team), representing 83% of enrolled patients (n=1,520). Patients treated at centers with a CLTI team had similar rates of unadjusted 1-year major amputation (7.9% team vs 12.1% no team, P=0.07) and MALE or death (29% team vs 33% no team, P=0.07). On multivariable analysis, presence of a CLTI team was independently associated with decreased major amputation (HR 0.66 [0.47-0.92], p=0.02) but no significant difference in MALE or death (HR 0.86 [0.23-1.03], p=0.09).
CONCLUSIONS: In the BEST-CLI trial, formally defined CLTI teams were associated with decreased risk of major amputation. This may be partially attributable to more effective communication and closer involvement of podiatry and wound care.
Back to 2025 Abstracts
