Treatment
8
Table 6. General Considerations on Invasive Treatment for
Intermittent Claudication
Recommendations Grade
Level of
Evidence
The SVS recommends endovascular therapy (EVT) or
surgical treatment of IC for patients with significant
functional or lifestyle-limiting disability when there is a
reasonable likelihood of symptomatic improvement with
treatment, when pharmacologic or exercise therapy, or both,
have failed, and when the benefits of treatment outweigh the
potential risks.
1 B
The SVS recommends an individualized approach to select
an invasive treatment for IC. The modality offered should
provide a reasonable likelihood of sustained benefit to the
patient (>50% likelihood of clinical efficacy for ≥2 years).
For revascularization, anatomic patency (freedom from
hemodynamically significant restenosis) is considered a
prerequisite for sustained efficacy.
1 C
Table 7. Interventions for Aortoiliac Occlusive Disease
(AIOD) in Intermittent Claudication
Recommendations Grade
Level of
Evidence
The SVS recommends endovascular procedures over open
surgery for focal AIOD causing IC.
1 B
The SVS recommends endovascular interventions as first-line
revascularization therapy for most patients with common iliac
artery or external iliac artery occlusive disease causing IC.
1 B
The SVS recommends the selective use of BMS or covered
stents for aortoiliac angioplasty for common iliac artery
or external iliac artery occlusive disease, or both, due to
improved technical success and patency.
1 B
The SVS recommends the use of covered stents for
treatment of AIOD in the presence of severe calcification
or aneurysmal changes where the risk of rupture may be
increased after unprotected dilation.
1 C
For patients with diffuse AIOD (eg, extensive aortic disease,
disease involving both common and external iliac arteries)
undergoing revascularization, the SVS suggests either
endovascular or surgical intervention as first-line approaches.
Endovascular interventions that may impair the potential
for subsequent aortofemoral bypass in surgical candidates
should be avoided.
2 B
