Frailty for Critical Limb Ischemia: Fruitful or Futile?

See Article by Takeji et al Critical limb ischemia (CLI), despite advancements in revascularization technology and technical approaches, continues to be associated with significant morbidity and mortality.1–3 Although most operators consider endovascular approach as the first-line therapy for CLI,2–5 controversy remains as to which approach (medical, endovascular, or surgical) is optimal. Classic considerations in the decision between endovascular versus surgical revascularization have been operator experience, anatomy, availability of conduit, age, and patient comorbidities. Meanwhile, those who are bedridden with or without severe dementia have usually been treated with medical therapy only or major amputation. The ultimate goal for CLI is to provide a therapy that would minimize suffering and allow independent ambulation. Accordingly, many risk scores, including BASIL (Bypass versus Angioplasty in Severe Ischemia of the Leg), PREVENT III (Edifoligide for the Prevention of Infrainguinal Vein Graft Failure), and FINNVASC (Finland National Vascular), have been developed to help in these decisions, but none are widely used. These risk scores, while informative, only provide data on measured comorbidities and lack information on other important risk factors, such as nutritional status, physical fitness, inflammation, degree of tissue loss, and overall health status of the patients. Therefore, a prognostic instrument that could potentially capture these unmeasured confounders would be of significant value in helping physicians and patients make proper treatment decisions and set appropriate expectations. To this end, Yamaji et al6 examined the prognostic value of frailty in patients with CLI. This current study6 adds to the growing body of literature to identify frailty as a potential prognostic measure in patients undergoing revascularization for CLI. The authors prospectively evaluated patients who presented with Rutherford classification IV-VI symptoms and risk-stratified them based on the clinical frailty scale. Clinical follow-up at 2 years demonstrated that those with …