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Background: The impact of a coordinated, multispecialty limb salvage program combined with aggressive multi-tibial revascularization upon limb salvage rates, survival, and cost of care has not previously been elucidated. The purpose of this paper is to present a clinical management algorithm developed over a 4-year period that can significantly improve amputation-free survival in critical limb ischemia (CLI) patients. Methods: This study is a prospective, single center analysis to evaluate the clinical, quality of care, and financial outcomes in CLI patients who undergo aggressive revascularization and wound care. Patient demographics, comorbidities, and procedure details were measured with outcomes tabulated at the index procedure and at successive 3-month intervals to 1 year. Results: A total of 186 patients who underwent endovascular interventions for Rutherford 4+ CLI were followed for a 1-year period between 2016 and 2019. The average ankleebrachial index improved from 0.49 ± 0.21 prior to treatment to 0.74 ± 0.23 at 1 year (P < 0.001). The immediate technical success rate was 95.7%, defined as the number of patients with inline flow from the aorta to the foot. About 33.4% of patients required a minor amputation and 7.3% of patients required a major amputation by 1 year. Crude all-cause mortality at 1 year was 17.7%. The total direct cost of care was $31,797 at 1 year, but significantly lower for the atherectomy with the drug-eluting stent group ($24,442, P < 0.001). About 5.7% of patients eventually required open surgical bypass. Conclusions: Inline revascularization paired with a coordinated limb salvage program can significantly improve outcomes in CLI patients. Appropriate endovascular management of CLI patients can lead to durable results with a high amputation-free survival.