Revascularization for claudication in lower extremity peripheral arterial disease

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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
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease

Recommendation for Revascularization for Claudication in the Patient with PAD

Class IIa

"1. Revascularization is a reasonable treatment option for the patient with lifestyle limiting claudication with an inadequate response to GDMT.(Level of Evidence: A)"

Recommendations for Endovascular Revascularization for Claudication:

Class I

"1. Endovascular procedures are effective as a revascularization option for patients with lifestyle-limiting claudication and hemodynamically significant aortoiliac occlusive disease.(Level of Evidence: A)"

Class III (Harm)

"1. Endovascular procedures should not be performed in patients with PAD solely to prevent progression to CLI.(Level of Evidence: B-NR)"

Class IIa

"1.Endovascular procedures are reasonable as a revascularization option for patients with lifestyle-limiting claudication and hemodynamically significant femoropopliteal disease.(Level of Evidence: B-R)"

Class IIb

"1.The usefulness of endovascular procedures as a revascularization option for patients with claudication due to isolated infrapopliteal artery disease is unknown.(Level of Evidence: C-LD)"

Recommendations for Surgical Revascularization for Claudication:

Class I

"1. When surgical revascularization is performed, bypass to the popliteal artery with autogenous vein is recommended in preference to prosthetic graft material.(Level of Evidence: A)"

Class III (Harm)

"1. Femoral-tibial artery bypasses with prosthetic graft material should not be used for the treatment of claudication.(Level of Evidence: B-R)"

"2. Surgical procedures should not be performed in patients with PAD solely to prevent progression to CLI.(Level of Evidence: B-NR)"

Class IIa

"1.Surgical procedures are reasonable as a revascularization option for patients with lifestyle-limiting claudication with inadequate response to GDMT, acceptable perioperative risk, and technical factors suggesting advantages over endovascular procedures.(Level of Evidence: B-NR)"