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CLINICAL STATEMENTS AND GUIDELINES

Circulation. 2024;149:e1313–e1410. DOI: 10.1161/CIR.0000000000001251 June 11, 2024 e1353

by professional societies to allow for tracking of revascularization procedures and patient outcomes with opportunities for local quality improvement initiatives and benchmarking compared with other centers.4,5

9 REVASCULARIZATION FOR

CLAUDICATION (CHRONIC SYMPTOMATIC PAD)

Patients with chronic symptomatic PAD have leg symptoms and functional limitation but do not have rest pain or tissue loss indicating CLTI (see Section 2, “Clinical Assessment for PAD”). An important manifestation of chronic symptomatic PAD is claudication, reproducible exertional leg symptoms that resolve with rest. Treatment for claudication includes medical therapy and foot care (see Section 5, “Medical Therapy and Preventive Foot Care for the Patient With PAD”), structured exercise (see Section 6, “Exercise Therapy for PAD”), and revascularization (endovascular, surgical, and hybrid procedures). Revascularization therapy is typically reserved for those patients with claudication who have not responded adequately to the former therapies (Figure 5). Most studies of revascularization for patients with chronic symptomatic PAD enrolled patients with claudication, which is therefore the focus of this section. The potential effects of revascularization on patients with chronic symptomatic PAD with leg symptoms other than claudication is an area in need of further study.

Figure 5. Algorithm for Revascularization for Claudication (Chronic Symptomatic PAD). Colors correspond to Table 3. GDMT indicates guideline-directed management and therapy; PAD, peripheral artery disease; and QOL, quality of life.

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