FOR IMMEDIATE RELEASE
A new publication from the BEST-CLI (Best Endovascular versus Best Surgical Therapy in Patients With Critical Limb Ischemia) collaboration, published in the Journal of Vascular Surgery, offers compelling evidence: patients with chronic limb-threatening ischemia (CLTI) experience significantly better outcomes when treated by multidisciplinary care teams.
The study, titled “Characteristics of multidisciplinary limb preservation teams and their impact on outcomes in the BEST-CLI trial,” evaluates whether the presence of a coordinated limb preservation team at trial sites influenced clinical outcomes in the largest randomized controlled trial to date for CLTI treatment.
Multidisciplinary collaboration is essential
CLTI is the most severe stage of peripheral artery disease and frequently occurs in patients with diabetes and multiple comorbidities. Effective management requires addressing vascular disease, wounds, infections, and functional impairment—making multidisciplinary collaboration essential.
The study analyzed data from over 1,500 patients across 110 international centers, identifying that only about one-third of those sites reported having a formally organized limb preservation team. The differences in patient outcomes were significant:
Major amputations reduced by 40% at team-based centers (Hazard Ratio 0.60, p = .005)
Greater podiatry and wound care involvement: Podiatrists served as primary caregivers at 32% of team sites versus 11% of non-team sites
Lower high–low amputation ratios: 0.20 at team sites versus 0.31, reflecting more minor, limb-sparing surgeries
Improved interdisciplinary communication: 71% of respondents at team sites rated collaboration as “highly effective,” compared to 29% at non-team sites
Implications for Practice
These findings support what clinicians and patient advocates have long observed: coordinated care improves limb preservation outcomes. Unlike previous single-center observational studies, this analysis stems from the rigorous, randomized setting of a large international clinical trial.
The study suggests that integrating podiatry, wound care, and vascular specialties into team-based approaches—not just episodically, but as a standard of care—can meaningfully reduce amputation rates and improve long-term outcomes for patients with CLTI.
The formation of multidisciplinary teams requires institutional commitment, resources, and collaboration across traditionally siloed specialties. But the return on this investment is clear: better patient function, fewer amputations, and stronger health system performance.
This analysis from the BEST-CLI trial offers a data-driven rationale for hospitals and healthcare systems to implement Limb Preservation Boards—mirroring the “tumor board” model long established in oncology.
Citation:
Jones DW, Farber A, Armstrong DG, Azene E, Duncan A, Todoran TM, Doros G, Strong MB, Rosenfield K, Conte MS, Menard MT. “Characteristics of multidisciplinary limb preservation teams and their impact on outcomes in the BEST-CLI trial.” J Vasc Surg. 2025; 1–11. doi:10.1016/j.jvs.2025.08.028
Media Contact:
Signe Sten Holst
Social Media & Communications Manager
📧 ssh@cap-partner.eu
ALPS Toe & Flow Resource Hub
This publication has been added to the ALPS Toe & Flow Hub — a curated educational platform showcasing the latest in interdisciplinary limb preservation.
The Toe & Flow model, introduced in 2010, emphasizes the critical partnership between podiatrists (toe) and vascular surgeons (flow). It has since expanded to include wound care, infectious disease, endocrinology, rehabilitation, and more —forming the foundation of modern, effective interdisciplinary diabetic foot care.
About ALPS
The American Limb Preservation Society (ALPS) is a nonprofit organization dedicated to eliminating preventable amputations through interdisciplinary collaboration, research, education, and advocacy. Learn more at: www.limbpreservationsociety.org