Mario Alejandro Fabiani, Jos C van den Berg, Oscar A De la Torre, Alfredo Verastegui, Anahita Dua, Vlad Adrian Alexandrescu, Amanjit S. Baadh, Nasr Bahaa, Juan Guillermo Barrera Carvajal, Robert Beasley, Lukla Biasi, Theodosios Bisdas, Erwin Blessing, Stefano Bonvini, Marianne Brodmann, Gonçalo Cabral, Roberto Cancellieri, Caroline Caradu, Andrea Casini, Venita Chandra, Emiliano Chisci, Omar Chohan, Edward Choke, Patrick Chong, Angelo Cioppa, Giacomo Clerici, Raphaël Coscas, Del Giudice Costantino, Mario D'Oria, Robert Davies, Gianmarco de Donato, Jean-Paul de Vries, Pablo Del Canto Peruyera, M.L. del Río-Solá, Koen Deloose, Sabeen Dhand, Αθανάσιος Διαμαντόπουλος, Larry J Díaz-Sandoval, Florian Dick, Gianmarco Falcone, Fabrizio Fanelli, Stefano Fazzini, Lucas Ferrer Cardona, Masahiko Fujihara, Karan Garg, Luca Garriboli, Elizabeth Genovese, Edward Gifford, Stefania Giuffrida, Yann Gouëffic, Peter Goverde, Prem Chand Gupta, Esteban Henao, Diego Jorge Herrera Vegas, Robert Hinchliffe, Jamal J. Hoballah, Andrew Holden, Dominic Howard, Bella Huasen, Osamu Iida, Giacomo Isernia, Konstantinos Katsanos, Philippe Kolh, Grigorios Korosoglou, Μiltiadis Krokidis, Alexandre Lecis, Marine Leopoldo, Mark L. Lessne, Michael Lichtenberg, Marta Lobato, Giorgio Loreni, Luís Loureiro, Kumar Madassery, Marco Manzi, Lieven Maene, Martin Maresch, Jorge Martinez Trabal, S Jay Mathews, Siah Michael, Bosiers Michel J, Bruno Migliara, Joseph Mills, Dimitrios Miserlis, Miguel Montero-Baker, Luis Morelli Alvarez, Robert Anthony Morgan, Daniele Morosetti, Nicolas Mouawad, Paul Moxey, Jose Antonio, Tatsuya Nakama, Richard Neville, Katariina Noronen, Mariano Palena, Sahil Parikh, Gianbattista Parlani, Edoardo Pasqui, Rafiuddin Patel, Ashish Patel, Lorenzo Patrone
INTRODUCTION: Revascularization to prevent limb loss is not feasible or represents a very high risk in a significant proportion of patients with chronic limb-threatening ischaemia (CLTI). No standard definition currently exists to define this population of patients. The aim of this study was to develop a consensus-based, multidomain definition to improve clinical assessment and reporting of studies in people with 'no option' (NO) or 'poor option' (PO) CLTI. METHODS: A modified Delphi process was conducted with 164 specialists from 30 countries. Two iterative survey rounds were used to reach consensus, defined as ≥70% agreement with a score of ≥7 on a nine-point scale. RESULTS: Some 164 international vascular specialists participated in the study, averaging 19 years of experience. A multidomain framework including arterial disease anatomy, biology, risk, function, and context (ABRFC) achieved 83% consensus. A 'desert foot' was defined as the absence of distal arterial revascularization targets on advanced non-invasive imaging, invasive digital subtraction angiography, and at least one failed endovascular revascularization attempt (81.6% agreement). Inadequate autogenous bypass conduit was defined as the lack of usable autologous vein across all four limbs (85% agreement). Patients were classified as NO for revascularization if they present with 'desert foot', prohibitive medical risk, a non-functional limb, or in those patients who refused arterial revascularization. PO revascularization patients combined factors such as severe infection, lack of autologous vein, or treatment non-compliance (72.1% agreement). CONCLUSION: This consensus study established a structured, expert-validated definition of no option or poor option for revascularisation of patients with CLTI. The multidomain ABRFC framework provides a foundation for standardized clinical assessment, trial design, and future guideline development.