Limb Anatomic Capital Across the Claudication-to-Chronic Limb-Threatening Ischemia Trajectory: A Scoping Review and Framework for Longitudinal Revascularization Stewardship.

PURPOSE: To explore whether claudication-stage management may affect native arterial substrate available for later revascularization options and propose a longitudinal stewardship framework. MATERIALS AND METHODS: A PRISMA-ScR review searched PubMed/MEDLINE across four domains: prior intervention and bypass outcomes, tibial runoff, procedural burden and conservative management, and no-option chronic limb-threatening ischemia (CLTI). RESULTS: Twenty-eight studies and guidelines were included. Prior ipsilateral endovascular intervention was associated in one study with higher 1-year major amputation (31% vs 20%) and graft occlusion (28% vs 18%). Three-year primary patency was 35.8% with absent tibial outflow versus 60.9% with intact runoff. Complete optimal medical therapy was documented in 38.1% at intervention; supervised exercise completion ranged from 5% to 55%. Approximately 20% of patients with CLTI were reported to lack a conventional revascularization option. CONCLUSIONS: Evidence supports prospective measurement of limb anatomic capital but does not separate natural disease progression from intervention-associated change. Proposed stewardship tools require prospective clinical validation.