Tables
Applied
Type
ModificationConfidence
95%
Created
Mar 19, 2026
Evidence
2 sources
Rationale
The integration focuses on the 2024 ACC/AHA/SVS guideline, which introduces significant updates to medical therapy for PAD, including the use of SGLT2 inhibitors and GLP-1 receptor agonists. Table 2.2 was expanded to include these new classes and refined to specify high-intensity statins and pharmacotherapy for smoking cessation. Table 2.1 was reinforced with a systematic review confirming the continued relevance of Fontaine/Rutherford classifications. Table 2.3 was updated to reflect current guideline preferences for surgical bypass in specific CLTI cohorts. Abbreviations were expanded on first use as required.
Evidence
Content Changes
removedadded
<!-- type: classification --> **Table 2.1. Fontaine and Rutherford Classification of peripheral arterialartery disease (PAD)** [@uyagu2022-quality], [@svs2024-b] | **Stage (Fontaine)** | **Rutherford Category** | **Clinical Presentation** | | --- | --- | --- | | I | 0 | Asymptomatic | | IIa/IIb | 1–3 | Claudication (mild–severe) | | III | 4 | Rest pain | | IV | 5–6 | Ulcer/gangrene | <!-- type: guidelines --> **Table 2.2. Evidence-Based Medical Therapy in PAD** | **Therapy** | **Major Trials** | **Key Findings** | | --- | --- | --- | | Smoking cessation | [Armstrong 2014]{@armstrong2014}, [Willigendael 2004]{@willigendael2004}2004]{@willigendael2004}, [@svs2024-b] | ↓ Mortality, ↓ limb lossloss; pharmacotherapy (e.g., varenicline) preferred | | Exercise therapy | [Cochrane 2017]{@lane2017} | ↑ Walking distance 50–200% | | Antiplatelets | [CAPRIE]{@caprie1996}[CAPRIE]{@caprie1996}, [@svs2024-b] | ↓ CVcardiovascular (CV) events, clopidogrel > aspirinaspirin; DAPT for 1-6 months post-revascularization | | Statins | [HPS]{@hps2002}, [4S]{@4s1994}[4S]{@4s1994}, [@svs2024-b] | High-intensity statins: ↓ CV events, improved patency post-revascularization | | Rivaroxaban + aspirin | [COMPASS]{@compass2017}[COMPASS]{@compass2017}, [@svs2024-b] | Dual pathway inhibition: ↓ major adverse cardiovascular events (MACE), ↓ major adverse limb events (MALE) | | SGLT2 inhibitors | [@svs2024-b] | Sodium-glucose cotransporter 2 (SGLT2) inhibitors: ↓ MACE, ↓ MALE, ↑↓ bleedingheart failure | | GLP-1 receptor agonists | [@svs2024-b] | Glucagon-like peptide-1 (GLP-1) receptor agonists: ↓ MACE in patients with diabetes | | Cilostazol | [Thompson 2002]{@thompson2002} | ↑ Claudication distance, no effect on CV outcomes | <!-- type: comparison --> **Table 2.3. Endovascular vs Surgical Revascularization** | **Approach** | **Indications** | **Outcomes** | **Limitations** | | --- | --- | --- | --- | | POBA | Short stenosis | High restenosis | Not durable | | DCB | Femoropopliteal | Superior patency vs POBA | Cost | | DES | Femoropopliteal | ↑ Patency | Limited length | | Covered stent | Iliac, femoropopliteal | Durable, relining option | Stent fracture | | Bypass (vein) | Long lesions, chronic limb-threatening ischemia (CLTI) | 80–90% 5-yr patencypatency; preferred for CLTI with suitable vein [@svs2024-b] | Major surgery | | Prosthetic bypass | No vein available | Acceptable iliac/femoral | Inferior distal | **References** 1. Fowkes FGR, et al. Global prevalence of PAD. *Lancet*. 2013. PubMed 2. Criqui MH, Aboyans V. Epidemiology of PAD. *Circ Res*. 2015. PubMed 3. Hiatt WR, et al. PAD as systemic disease. *NEJM*. 2015. PubMed 4. Willigendael EM, et al. Smoking and PAD. *J Vasc Surg*. 2004. PubMed 5. Conte MS, et al. Global Vascular Guidelines on CLTI. *J Vasc Surg*. 2019. PubMed 6. van Engelen A, et al. AI in PAD imaging. *Eur Heart J*. 2020. PubMed 7. Aboyans V, et al. ESVS/SVS Guidelines on PAD. *Eur J Vasc Endovasc Surg*. 2018. PubMed 8. CAPRIE Steering Committee. Clopidogrel vs aspirin. *Lancet*. 1996. PubMed 9. Eikelboom JW, et al. COMPASS trial. *NEJM*. 2017. PubMed 10. Gaba GW, et al. 2024 ACC/AHA/SVS Guideline for PAD. *J Am Coll Cardiol*. 2024. PubMed 11. Uyagu OD, et al. Quality assessment of PAD guidelines. *BMJ Open*. 2022. PubMed