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Treatment
9.1. Revascularization for Claudication
COR LOE
Recommendations
Revascularization for Claudication: Initial Decision-Making
1 B-NR
1. In patients with functionally limiting claudication who are
being considered for revascularization, potential benefits with
respect to QOL, walking performance, and overall functional
status should be weighed against the risks and durability of
intervention and possible need for repeated procedures.
2a B-R
2. In patients with functionally limiting claudication and
an inadequate response to GDMT (including structured
exercise), revascularization is a reasonable treatment option to
improve walking function and QOL.
3: No
Benefit
C-EO
3. In patients with claudication who have had an adequate
clinical response to GDMT (including structured exercise),
revascularization is not recommended.
Revascularization for Claudication: Aortoiliac Disease and Femoropopliteal Disease
(Excluding Common Femoral Artery Disease)
1 A
4. In patients with functionally limiting claudication and
hemodynamically significant aortoiliac or femoropopliteal
disease with inadequate response to GDMT (including
structured exercise), endovascular revascularization is
effective to improve walking performance and QOL.
2a B-NR
5. In patients with functionally limiting claudication and
hemodynamically significant aortoiliac or femoropopliteal
disease with inadequate response to GDMT (including
structured exercise), surgical revascularization is reasonable if
perioperative risk is acceptable and technical factors suggest
advantages over endovascular approaches.
Revascularization for Claudication: Common Femoral Artery Disease
2a B-R
6. In patients with functionally limiting claudication and
hemodynamically significant common femoral artery disease
with inadequate response to GDMT (including structured
exercise), surgical endarterectomy is reasonable, especially if
endovascular approaches adversely affect profunda femoris
artery pathways.
2b B-R
7. In patients with functionally limiting claudication and
hemodynamically significant common femoral artery disease
with inadequate response to GDMT (including structured
exercise), endovascular approaches may be considered in
those at high risk for surgical revascularization and/or if
anatomical factors are favorable (ie, no adverse effect on
profunda femoris artery pathways).
