Abstract Background Racial and ethnic disparities are recognised throughout medicine, but their impact on Chronic Limb Threatening Ischaemia (CLTI) remains underexplored. This study aimed to identify disparities in CLTI management and outcomes across racial and ethnic groups. Methods Systematic review and meta-analysis conducted in accordance with the PRISMA guidelines (PROSPERO registration CRD42024598669). Embase, MEDLINE, and Ovid were searched for studies reporting CLTI treatment strategies (for example revascularisation versus amputation) and outcomes (e,g., mortality, graft failure/reintervention) stratified by race or ethnicity. Results Thirteen studies, all USA-based, met inclusion criteria. African American (OR 1.62 95%c.i. 1.22,2.15, I2 98%, n = 5) and Hispanic patients (OR 1.41 1.17,1.70, I2 26%, n = 4) had higher odds of amputation without prior revascularisation attempt. Bypass failure risk was non-significantly elevated for African American (RR 1.40 (0.96, 2.03), I2 = 92%, n = 4) and increased for Hispanic patients in one study. No significant difference in short term mortality risk was reported for African American (RR 1.06 (0.38, 2.95), I2 = 92%, n = 3) or for Hispanic patients in one study. Significant heterogeneity was observed and certainty of evidence, assessed using GRADE was low. Conclusions Racial and ethnic disparities in CLTI management are evident, with minorities experiencing higher odds of amputation without prior revascularisation. Interpretation is constrained by inconsistent definitions (for example grouping of CLTI with intermittent claudication) and a paucity of high-quality and disaggregated data. Standardisation of definitions and reporting are needed, alongside further robust research, to better understand these racial and ethnic disparities and inform the development of equitable treatment pathways.
Shaltout et al. (2026) studied this question.