Peripheral arterial disease classification

Peripheral arterial disease Microchapters
Home
Patient Information
Overview
Classification
Pathophysiology
Causes
Differentiating Peripheral arterial disease from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Guidelines for Management
Case Studies
Case #1
AHA/ACC Guidelines on Management of Lower Extremity PAD
Guidelines for Clinical Assessment of Lower Extremity PAD
Guidelines for Diagnostic Testing for suspected PAD
Guidelines for Screening for Atherosclerotic Disease in Other Vascular Beds in patients with Lower Extremity PAD
Guidelines for Medical Therapy for Lower Extremity PAD
Guidelines for Structured Exercise Therapy for Lower Extremity PAD
Guidelines for Minimizing Tissue Loss in Lower Extremity PAD
Guidelines for Revascularization of Claudication in Lower Extremity PAD
Guidelines for Management of CLI in Lower Extremity PAD
Guidelines for Management of Acute Limb Ischemial in Lower Extremity PAD
Guidelines for Longitudinal Follow-up for Lower Extremity PAD
Peripheral arterial disease classification On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Peripheral arterial disease classification All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Peripheral arterial disease classification
CDC on Peripheral arterial disease classification
Peripheral arterial disease classification in the news
Blogs on Peripheral arterial disease classification
Directions to Hospitals Treating Peripheral arterial disease
Risk calculators and risk factors for Peripheral arterial disease classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assocommon iliac arteryte Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2], Rim Halaby

Overview

Peripheral arterial disease is commonly divided in the Fontaine stages, introduced by Dr René Fontaine in 1954. A more recent classification by Rutherford consists of three grades and six categories. In addition, the American College of Cardiology/American Heart Assocommon iliac arterytion (ACC/AHA) uses a symptoms-based classification (absence of symptoms, claudication, critical limb ischemia and acute limb ischemia) in their guidelines.

Classification

Fontaine Stages

• Stage I: asymptomatic
• Stage II a: mild claudication
• Stage II b: moderate to severe claudication for relatively shorter distances
• Stage III: ischemia rest pain
• Stage IV: ulceration or tissue loss (gangrene)

Rutherford Categories

• Grade 0, Category 0: asymptomatic
• Grade I, Category 1: mild claudication
• Grade I, Category 2: moderate claudication
• Grade I, Category 3: severe claudication
• Grade II, Category 4: ischaemia rest pain
• Grade III, Category 5: minor tissue loss
• Grade IV, Category 6: major tissue loss

Shown below is an image showing the difference between Fontaine's and Rutherford's classification.

Classification of PAD

Classification Used in American College of Cardiology/American Heart Assocommon iliac arterytion (ACC/AHA) Practice Guidelines

• Absence of symptoms
• Claudication
• Critical/chronic limb ischaemia
• Acute limb ischaemia

TASC Morphological Stratification

TASC (TransAtlantic Inter-Society Consensus) morphological consensus is used to guide the choice between endovascular and surgical revarscularization in patients with peripheral artery disease.

Morphological Stratification of Iliac Lesions

• TASC type A iliac lesions:
  • Single stenosis less than 3 cm of the common iliac artery or external iliac artery (unilateral/bilateral)
• TASC type B iliac lesions:
  • Single stenosis 3 to 10 cm in length, not extending into the common femoral artery, or
  • Total of 2 stenoses less than 5 cm long in the common iliac artery and/or external iliac artery and not extending into the common femoral artery, or
  • Unilateral common iliac artery occlusion
• TASC type C iliac lesions:
  • Bilateral 5- to 10-cm-long stenosis of the common iliac artery and/or external iliac artery, not extending into the common femoral artery, or
  • Unilateral external iliac artery occlusion not extending into the common femoral artery, or
  • Unilateral external iliac artery stenosis extending into the common femoral artery, or
  • Bilateral common iliac artery occlusion
• TASC type D iliac lesions:
  • Diffuse, multiple unilateral stenoses involving the common iliac artery, external iliac artery, and common femoral artery (usually more than 10 cm long), or
  • Unilateral occlusion involving both the common iliac artery and external iliac artery, or
  • Bilateral external iliac artery occlusions, or
  • Diffuse disease involving the aorta and both iliac arteries, or
  • Iliac stenoses in a patient with an abdominal aortic aneurysm orother lesion requiring aortic or iliac surgery

Morphological Stratification of Femoropopliteal Lesions

• TASC type A femoropopliteal lesions:
  • Single stenosis less than 3 cm of the superficial femoral artery or popliteal artery
• TASC type B femoropopliteal lesions:
  • Single stenosis 3 to 10 cm in length, not involving the distal popliteal artery
  • Heavily calcified stenoses up to 3 cm in length
  • Multiple lesions, each less than 3 cm (stenoses or occlusions)
  • Single or multiple lesions in the absence of continuous tibial runoff to improve inflow for distal surgical bypass
• TASC type C femoropopliteal lesions:
  • Single stenosis or occlusion longer than 5 cm
  • Multiple stenoses or occlusions, each 3 to 5 cm in length, with or without heavy calcification
• TASC type D femoropopliteal lesions:

Complete common femoral artery or superficial femoral artery occlusions or complete popliteal and proximal trifurcation occlusions

References

Template:WikiDoc Sources