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©2013 UpToDate ® Print Email ACC/AHA guideline summary: Prevention of critical limb ischemia Class I - There is evidence and/or generalagreement for the following approach to the prevention of critical limbischemia •  Patients at risk of CLI, defined as an diabetic patient with known lower extremity peripheral arterial disease or an ABI less than 0.4 in a nondiabetic patient, should undergo regular inspection of the feet to detect objective signs of CLI. •  The feet should be examined with shoes and socks removed. •  Patients who have been successfully treated for CLI are at relatively high risk for recurrence. They should be evaluated at least twice yearly by a vascular specialist and be given verbal and written instructions for self-surveillance for recurrence. Adapted from Hirsch, AT, Haskal, ZJ, Hertzer, NR, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation 2006; 113:e463.