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Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. <i>J Vasc Surg<\/i> 2019; 69: 3S\u2013125S."},{"key":"2","doi-asserted-by":"crossref","unstructured":"2. Gallagher KA, Mills JL, Armstrong DG, Conte MS, Kirsner RS, Minc SD, et al. Current status and principles for the treatment and prevention of diabetic foot ulcers in the cardiovascular patient population: A scientific statement from the American Heart Association. <i>Circulation<\/i> 2024; 149: e232\u2013e253.","DOI":"10.1161\/CIR.0000000000001192"},{"key":"3","doi-asserted-by":"publisher","unstructured":"3. Lanzer P, Schurgers L, Twarda-Clapa A, Ferraresi R, Hui H, Kamenskiy A, et al. Medial arterial calcification in ageing and disease: Current evidence and knowledge gaps. <i>Eur Heart J<\/i> 2025; 46: 4876\u20134900, doi:10.1093\/eurheartj\/ehaf341.","DOI":"10.1093\/eurheartj\/ehaf341"},{"key":"4","doi-asserted-by":"crossref","unstructured":"4. Chen Y, Zhao X, Wu H. Arterial stiffness: A focus on vascular calcification and its link to bone mineralization. <i>Arterioscler Thromb Vasc Biol<\/i> 2020; 40: 1078\u20131093.","DOI":"10.1161\/ATVBAHA.120.313131"},{"key":"5","doi-asserted-by":"crossref","unstructured":"5. Gornik HL, Aronow HD, Goodney PP, Arya S, Brewster LP, Byrd L, et al. 2024 ACC\/AHA\/AACVPR\/APMA\/ABC\/SCAI\/SVM\/SVN\/SVS\/SIR\/VESS Guideline for the management of lower extremity peripheral artery disease: A report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines. <i>J Am Coll Cardiol<\/i> 2024; 83: 2497\u20132604.","DOI":"10.1161\/CIR.0000000000001251"},{"key":"6","doi-asserted-by":"crossref","unstructured":"6. Soga Y, Takahara M, Yamauchi Y, Iida O, Fujihara M, Kawasaki D, et al. Efficacy of Rheocarna<sup>\u00ae<\/sup>, a novel apheresis device, in patients with no- or poor-option chronic limb-threatening ischemia. <i>Circ J<\/i> 2025; 89: 557\u2013565.","DOI":"10.1253\/circj.CJ-24-0830"},{"key":"7","doi-asserted-by":"crossref","unstructured":"7. Ogata K, Nishihira K, Asano Y, Honda Y, Yamamoto K, Emori H, et al. Clinical comparison of drug-coated balloon and drug-eluting stent for femoropopliteal lesions in chronic limb-threatening ischemia with wounds. <i>Circ J<\/i> 2024; 88: 1647\u20131655.","DOI":"10.1253\/circj.CJ-24-0176"},{"key":"8","doi-asserted-by":"crossref","unstructured":"8. Tokuda T, Yoshioka N, Tanaka A, Kojima S, Yamaguchi K, Yanagiuchi T, et al. Endovascular treatment alone vs. endovascular treatment plus rheocarna for patients with chronic limb-threatening ischemia: Multicenter comparative study. <i>Circ Rep<\/i> 2025; 8: 333\u2013342.","DOI":"10.1253\/circrep.CR-25-0257"},{"key":"9","doi-asserted-by":"crossref","unstructured":"9. Miyake K, Kikuchi S, Uchida D, Doita T, Miyagawa S, Azuma N, et al. The impact of angiographic pedal circulation status on wound healing in chronic limb-threatening ischaemia after bypass surgery. <i>J Vasc Surg<\/i> 2024; 80: 1836\u20131846.","DOI":"10.1016\/j.jvs.2024.08.023"},{"key":"10","doi-asserted-by":"crossref","unstructured":"10. Iida O, Takahara M, Ohura N, Hata Y, Kodama A, Soga Y, et al. Editor\u2019s choice: Impact of infrapopliteal revascularization establishing in line flow to the wound in patients with chronic limb threatening ischaemia. <i>Eur J Vasc Endovasc Surg<\/i> 2024; 68: 631\u2013638.","DOI":"10.1016\/j.ejvs.2024.07.024"},{"key":"11","doi-asserted-by":"crossref","unstructured":"11. Hata Y, Iida O, Masuda M, Okamoto S, Ishihara T, Nanto K, et al. Incidence of angiographic deterioration following inframalleolar angioplasty and its impact on outcomes in patients with chronic limb-threatening ischemia requiring repeat intervention. <i>Circ Rep<\/i> 2024; 6: 514\u2013520.","DOI":"10.1253\/circrep.CR-24-0103"},{"key":"12","doi-asserted-by":"crossref","unstructured":"12. Farber A. Chronic limb-threatening ischemia. <i>N Engl J Med<\/i> 2018; 379: 171\u2013180.","DOI":"10.1056\/NEJMcp1709326"},{"key":"13","doi-asserted-by":"crossref","unstructured":"13. Fitridge R, Pena G, Mills JL. The patient presenting with chronic limb-threatening ischaemia. <i>Diabetes Metab Res Rev<\/i> 2020; 36: e3242.","DOI":"10.1002\/dmrr.3242"},{"key":"14","doi-asserted-by":"crossref","unstructured":"14. Criqui MH, Matsushita K, Aboyans V, Hess CN, Hicks CW, Kwan TK, et al. Lower extremity peripheral artery disease: Contemporary epidemiology, management gaps, and future directions: A scientific statement from the American Heart Association. <i>Circulation<\/i> 2021; 144: e171\u2013e191.","DOI":"10.1161\/CIR.0000000000001005"},{"key":"15","doi-asserted-by":"crossref","unstructured":"15. Naiem AA, Bergeron A, MacKenzie KS, Obrand DI, Steinmetz OK, Bayne JP, et al. Severe inframalleolar disease is an independent predictor of adverse limb outcomes after endovascular revascularization in chronic limb-threatening ischemia. <i>J Vasc Surg<\/i> 2023; 77: 858\u2013863.","DOI":"10.1016\/j.jvs.2022.10.042"},{"key":"16","doi-asserted-by":"crossref","unstructured":"16. Almasri J, Adusumalli J, Asi N, Lakis S, Alsawas M, Prokop LJ, et al. A systematic review and meta-analysis of revascularization outcomes of infrainguinal chronic limb-threatening ischemia. <i>Eur J Vasc Endovasc Surg<\/i> 2019; 58: S110\u2013S119.","DOI":"10.1016\/j.ejvs.2019.04.013"},{"key":"17","doi-asserted-by":"crossref","unstructured":"17. Maxwell AJ, Schauble E, Bernstein D, Cooke JP. Limb blood flow during exercise is dependent on nitric oxide. <i>Circulation<\/i> 1998; 98: 369\u2013374.","DOI":"10.1161\/01.CIR.98.4.369"},{"key":"18","doi-asserted-by":"crossref","unstructured":"18. Green DJ, Spence A, Halliwill JR, Cable NT, Thijssen DHJ. Vascular adaptation to exercise in humans: Role of hemodynamic stimuli. <i>J Physiol<\/i> 2017; 595: 2391\u20132409.","DOI":"10.1152\/physrev.00014.2016"},{"key":"19","doi-asserted-by":"crossref","unstructured":"19. Suvorava T, Lauer N, Kojda G. Physical inactivity causes endothelial dysfunction in humans. <i>J Am Coll Cardiol<\/i> 2004; 44: 1320\u20131327.","DOI":"10.1016\/j.jacc.2004.06.030"},{"key":"20","doi-asserted-by":"crossref","unstructured":"20. Okada K, Nakabachi M, Hayashi Y. Alteration in carotid arterial stiffness during passive leg raising may reflect vascular endothelial function. <i>Circ Rep<\/i> 2025; 7: 988\u2013994.","DOI":"10.1253\/circrep.CR-25-0047"},{"key":"21","doi-asserted-by":"crossref","unstructured":"21. Izawa KP, Oka K. Focusing on sedentary behavior in comprehensive cardiac rehabilitation. <i>Circ Rep<\/i> 2024; 6: 481\u2013488.","DOI":"10.1253\/circrep.CR-24-0098"},{"key":"22","doi-asserted-by":"publisher","unstructured":"22. Iwata S, Mizuguchi Y, Suzuki R, Hosoi Y, Miwa T, Tan M, et al. Endovascular therapy outcomes in patients with the Global Limb Anatomical Staging System P2 modifier to identify the true no-option anatomic pattern in chronic limb-threatening ischemia. <i>J Vasc Surg<\/i> 2025; 82: 2090\u20132101.e3, doi:10.1016\/j.jvs.2025.07.015.","DOI":"10.1016\/j.jvs.2025.07.015"},{"key":"23","doi-asserted-by":"crossref","unstructured":"23. Morisaki K, Matsuda D, Matsubara Y, Kurose S, Yoshino S, Kinoshita G, et al. Global limb anatomic staging system inframalleolar modifier predicts limb salvage and wound healing in patients with chronic limb threatening ischaemia undergoing endovascular infrainguinal revascularisation. <i>Eur J Vasc Endovasc Surg<\/i> 2023; 65: 391\u2013397.","DOI":"10.1016\/j.ejvs.2022.11.023"},{"key":"24","doi-asserted-by":"crossref","unstructured":"24. Meloni M, Izzo V, Giurato L, Gandini R, Uccioli L. Below-the-ankle arterial disease severely impairs the outcomes of diabetic patients with ischemic foot ulcers. <i>Diabetes Res Clin Pract<\/i> 2019; 152: 9\u201315.","DOI":"10.1016\/j.diabres.2019.04.031"},{"key":"25","doi-asserted-by":"crossref","unstructured":"25. Alexandrescu VA, Brochier S, Schoenen S, Antonelli E, Azdad K, Zekhnini I, et al. Grades of below-the-ankle arterial occlusive disease following the angiosome perfusion: A new morphological assessment and correlations with the inframalleolar GVG stratification in CLTI patients. <i>Ann Vasc Surg<\/i> 2022; 81: 358\u2013377.","DOI":"10.1016\/j.avsg.2021.09.031"},{"key":"26","doi-asserted-by":"crossref","unstructured":"26. Sullivan AE, Behroozian A, Coolbaugh C, Shardelow E, Smith EK, Wells QS, et al. Microvascular function and ambulatory capacity in peripheral artery disease. <i>Circ Cardiovasc Interv<\/i> 2025; 18: e015582.","DOI":"10.1161\/CIRCINTERVENTIONS.125.015582"},{"key":"27","doi-asserted-by":"crossref","unstructured":"27. Arora S, Pomposelli F, LoGerfo FW, Veves A. Cutaneous microcirculation in the neuropathic diabetic foot improves significantly but not completely after successful lower extremity revascularization. <i>J Vasc Surg<\/i> 2002; 35: 501\u2013505.","DOI":"10.1067\/mva.2002.121126"},{"key":"28","doi-asserted-by":"crossref","unstructured":"28. Sapienza P, Mingoli A, Borrelli V, Grande R, Sterpetti AV, Biacchi D, et al. Different inflammatory cytokines release after open and endovascular reconstructions influences wound healing. <i>Int Wound J<\/i> 2019; 16: 1034\u20131044.","DOI":"10.1111\/iwj.13154"},{"key":"29","doi-asserted-by":"crossref","unstructured":"29. Metser G, Puma J, Mustapha J, Adams GL, Ratcliffe J, Khullar P, et al. 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