Abstract
Objective: The Global Vascular Guidelines on the Management of Chronic Limb-Threatening
Ischemia provide a framework for assessment and management of patients with chronic limbthreatening ischaemia (CLTI). This audit describes compliance with Global Vascular Guidelines
(GVG) standards across two teaching hospitals in different healthcare settings.
Design: This is a prospective, cross-sectional, clinical audit conducted over a 1-month period.
Methods: All new CLTI patients admitted or seen in the outpatient podiatry clinic at Guy’s and
St Thomas’ Hospital (GSTT) and the National Hospital of Sri Lanka (NHSL) between 1 May
2024 and 31 May 2024 were included. Data were collected regarding clinical assessment,
scoring system and imaging utilisation according to recommendations set out in the GVG.
Statistical significance was analysed with Fisher’s exact test using SPSS.
Results: 65 inpatients were included (GSTT: 38; NHSL: 27) and 49 outpatients (GSTT: 21;
NHSL: 28). Among the inpatients, GVG-compliant medical history was recorded in 57 (88%)
cases (GSTT: 32 (84%); NHSL: 25 (93%), p=0.311). GVG-compliant foot examination was
completed in 10 (15%) patients (GSTT: 10 (26%); NHSL: 0 (0%), p=0.004). Use of noninvasive imaging was consistent between groups. Among the outpatients, GVG-compliant foot
examinations were performed in all 21 outpatients at GSTT (100%) but in none of the 28
outpatients at NHSL (0%, p<0.001). Limb severity scoring systems were used for all
outpatients seen at GSTT (21/21, 100%), whereas only 5 of 28 outpatients at NHSL (18%) had
scoring systems documented (p<0.001). Non-invasive imaging utilisation was comparable
between the two institutions for outpatients.
Conclusions: Implementation of the GVG is challenging, with even large teaching hospital
centres failing to meet all the recommendations for assessment of patients with CLTI.