{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T17:42:44Z","timestamp":1792258964599,"version":"4.4.0"},"reference-count":39,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Angiology"],"abstract":"<jats:p>Chronic limb-threatening ischemia (CLTI) carries 1-year mortality of 20% to 25%, comparable with many solid-organ malignancies. Technically successful revascularization, defined by anatomical patency, does not reliably deliver pain relief, restored function, or sustained quality of life. This narrative review synthesizes landmark randomized trials (BEST-CLI, BASIL-1, BASIL-2) and current European and United States guidelines, grading every claim with a scheme in which population indirectness downgrades design strength. We examine 4 domains of morbidity persisting after anatomically successful revascularization: mechanistically heterogeneous pain; functional and quality-of-life decline; psychological burden; and sustained health care use, including chronic opioid use (approximately 35%), unhealed wounds at 1 year (10%-32%), and unplanned 30-day readmission (approximately 25%). No patient-reported outcome measure has been validated specifically for CLTI or used as a co-primary trial endpoint. We propose an accountability gap: the under-measured transfer of unresolved morbidity from vascular services to primary care. We state it as a falsifiable prediction about the discrimination of patency rather than prevalence, with a pre-specified effect size, explicit treatment of death as a competing risk, and a core outcome battery justified against COSMIN criteria. Patient co-production is the indispensable next step.<\/jats:p>","DOI":"10.1177\/00033197261494448","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T06:45:58Z","timestamp":1791873958000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Patency: Patient-Centered Outcomes and the Proposed Accountability Gap in Chronic Limb-Threatening Ischemia"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2580-1704","authenticated-orcid":false,"given":"Luca","family":"Galassi","sequence":"first","affiliation":[{"name":"Postgraduate School of Vascular and Endovascular Surgery, University of Milan, Milan, Italy"},{"name":"Vascular Surgery Unit, ASST Lecco, Ospedale Alessandro Manzoni, Lecco, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0970-3409","authenticated-orcid":false,"given":"Federica","family":"Facchinetti","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1134-2068","authenticated-orcid":false,"given":"Carlo","family":"Banfi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Surgery, CHU UCL Namur, Universit\u00e9 catholique de Louvain (UCLouvain), Yvoir, Belgium"},{"name":"Geneva Hemodynamic Research Group, University of Geneva, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61249-0"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2019.02.016"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2009.08.073"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67704-5"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2010.01.076"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2207899"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)00462-2"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2013.08.099"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/geronj\/49.2.M85"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-018-1829-0"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2021.11.057"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.121.011320"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx095"},{"key":"e_1_3_4_16_2","volume-title":"Peripheral Arterial Disease: Diagnosis and Management (CG147)","author":"National Institute for Health and Care Excellence","unstructured":"National Institute for Health and Care Excellence. Peripheral Arterial Disease: Diagnosis and Management (CG147). NICE; 2012 (updated 2020)."},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae179"},{"key":"e_1_3_4_18_2","article-title":"ACC\/AHA\/AACVPR\/APMA\/ABC\/SCAI\/SVM\/SVN\/SVS\/SIR\/VESS guideline for the management of lower extremity peripheral artery disease","volume":"149","author":"Gornik HL","year":"2024","unstructured":"Gornik HL, Aronow HD, Goodney PP, et al. 2024 ACC\/AHA\/AACVPR\/APMA\/ABC\/SCAI\/SVM\/SVN\/SVS\/SIR\/VESS guideline for the management of lower extremity peripheral artery disease. Circulation. 2024;149:e1313-e1410.","journal-title":"Circulation"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-017-1978-4"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/HCQ.0000000000000135"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2021.07.236"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.2147\/CIA.S272078"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2020.11.043"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001178"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1177\/15385744221144389"},{"key":"e_1_3_4_26_2","doi-asserted-by":"crossref","unstructured":"Ochoa Chaar CI Gholitabar N Goodney P Dardik A Abougergi MS. One-year readmission after open and endovascular revascularization for critical limb ischemia. Ann Vasc Surg. 2019;61:25-32.e2.","DOI":"10.1016\/j.avsg.2019.07.003"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2017.12.012"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2023.11.003"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1611688"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.109.930735"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1177\/1358863X231181613"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2025.07.032"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e256"},{"key":"e_1_3_4_34_2","article-title":"Decision aids for people facing health treatment or screening decisions","volume":"4","author":"Stacey D","year":"2017","unstructured":"Stacey D, L\u00e9gar\u00e9 F, Lewis K, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2017;4:CD001431.","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_4_35_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2013.5143"},{"key":"e_1_3_4_36_2","article-title":"Impact of patient and public involvement on enrolment and retention in clinical trials: systematic review and meta-analysis","volume":"363","author":"Crocker JC","year":"2018","unstructured":"Crocker JC, Ricci-Cabello I, Parker A, et al. Impact of patient and public involvement on enrolment and retention in clinical trials: systematic review and meta-analysis. BMJ. 2018;363:k4738.","journal-title":"BMJ"},{"key":"e_1_3_4_37_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.17.1822"},{"key":"e_1_3_4_38_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000623"},{"key":"e_1_3_4_39_2","doi-asserted-by":"publisher","DOI":"10.1097\/HJR.0b013e328334f42d"},{"key":"e_1_3_4_40_2","doi-asserted-by":"publisher","DOI":"10.1177\/2047487316671181"}],"container-title":["Angiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00033197261494448","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00033197261494448","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00033197261494448","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T16:55:04Z","timestamp":1792256104000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00033197261494448"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,12]]},"references-count":39,"alternative-id":["10.1177\/00033197261494448"],"URL":"https:\/\/doi.org\/10.1177\/00033197261494448","relation":{},"ISSN":["0003-3197","1940-1574"],"issn-type":[{"value":"0003-3197","type":"print"},{"value":"1940-1574","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,12]]},"article-number":"00033197261494448"}}