20
Treatment
Table 28. Surgical Revascularization for Claudication
COR LOE
Recommendations
I A When surgical revascularization is performed, bypass to the
popliteal artery with autogenous vein is recommended in
preference to prosthetic gra material.
IIa B-NR 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.
III:
Harm
B-R Femoral-tibial artery bypasses with prosthetic gra material
should NOT be used for the treatment of claudication.
III:
Harm
B-NR Surgical procedures should NOT be performed in patients with
PAD solely to prevent progression to CLI.
Management of CLI
Table 29. Revascularization for CLI
COR LOE
Recommendations
I B-NR In patients with CLI, revascularization should be performed
when possible to minimize tissue loss.
I C-EO An evaluation for revascularization options should be performed
by an interdisciplinary care team (Table 25) before amputation in
the patient with CLI.
Table 30. Endovascular Revascularization for CLI
COR LOE
Recommendations
I B-R Endovascular procedures are recommended to establish
in-line blood flow to the foot in patients with nonhealing
wounds or gangrene.
IIa C-LD A staged approach to endovascular procedures is reasonable in
patients with ischemic rest pain.
IIa B-R Evaluation of lesion characteristics can be useful in selecting the
endovascular approach for CLI.
IIb B-NR Use of angiosome-directed endovascular therapy may be
reasonable for patients with CLI and non-healing wounds
or gangrene.
