Is “No-Option Critical Limb Threatening Ischaemia” a Right Definition? A Paradigm Shift Driven by Autologous Cell Therapy for Diabetic Foot Disease

Diabetic foot ulcers (DFUs) complicated by chronic limb threatening ischemia (CLTI) is one of the most severe pattern of diabetic foot disease (DFD). Although significant improvements in the management of CLTI by the availability of advanced devices and the use of extreme revascularization techniques, there is still a group of patients with unreconstructable vascular disease. These patients have a high risk of major amputation and are commonly defined as no-option CLTI subjects. Nonetheless, by the recent availability of autologous cell therapy (ACT), mainly mononuclear cell therapy, the natural history of no-option CLTI seems to change by a significant improvement in the rate of wound healing and limb salvage. Therefore, authors suggest that the term "no-option CLTI" may no longer be appropriate, as these patients could still have a second chance to achieve limb salvage even after failed revascularization procedures. This editorial highlights the practical implications of ACT for diabetic foot patients with unreconstructable vascular disease, suggesting a new definition and future perspectives.