In critical limb ischemia (CLI), the Rutherford classification grade III category 6 indicates which clinical presentation?

• A Major tissue loss extending above transmetatarsal level; foot not salvageable ✓
• B Rest pain only, no tissue loss
• C Minor tissue loss (non-healing ulcer or focal gangrene with diffuse pedal ischemia)
• D Mild claudication at distances > 200 m

Explanation

The Rutherford classification for peripheral arterial disease: Grade I categories 1-3 = mild to severe claudication; Grade II category 4 = ischemic rest pain; Grade III category 5 = minor tissue loss (ischemic ulceration not exceeding digits, focal gangrene); Grade III category 6 = major tissue loss (gangrene extending above transmetatarsal level, foot not salvageable without major amputation). Category 6 represents irreversible ischemic damage requiring major amputation. This differs from the Fontaine classification where Stage IV covers all tissue loss collectively.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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