Aortoiliac Occlusive Disease Guidelines

Updated: Aug 21, 2017
  • Author: Khanjan H Nagarsheth, MD, MBA; Chief Editor: Vincent Lopez Rowe, MD  more...
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Guidelines

SVS Guideline for Asymptomatic PAD and Intermittent Claudication

In March 2015, the Practice Guidelines Committee of the Society for Vascular Surgery (SVS) issued specific practice recommendations for the treatment of asymptomatic peripheral artery disease (PAD) and intermittent claudication in patients with atherosclerotic disease of the lower extremities. [12]  Among the recommendations were the following:

  • Emphasis is placed on risk factor modification, medical therapies, and broader use of exercise programs to improve cardiovascular health and functional performance
  • Screening for PAD appears of unproven benefit at present
  • Revascularization for intermittent claudication is appropriate for selected patients with disabling symptoms, after a careful risk-benefit analysis; treatment should be individualized according to comorbid conditions, degree of functional impairment, and anatomic factors
  • Invasive treatments for intermittent claudication should provide predictable functional improvements with reasonable durability (suggested minimum threshold, >50% chance of sustained efficacy for ≥2 years); anatomic patency is considered a prerequisite for sustained efficacy
  • Endovascular approaches are favored for most candidates with aortoiliac disease
  • Caution is warranted with interventions for intermittent claudication when durability is limited (eg, extensive calcification, small-caliber arteries, diffuse infrainguinal disease, poor runoff); in such cases (if patients are otherwise good-risk) and in cases of previous endovascular failure, surgical bypass may be preferred
  • Patients who undergo invasive treatments for intermittent claudication should be monitored regularly in a surveillance program