Semin intervent Radiol 2014; 31(04): 378-388
DOI: 10.1055/s-0034-1393976
Clinical Corner
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Overview of Classification Systems in Peripheral Artery Disease

Rulon L. Hardman
1   Department of Radiology, University of Colorado Denver, Aurora, Colorado
,
Omid Jazaeri
1   Department of Radiology, University of Colorado Denver, Aurora, Colorado
2   Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, University of Colorado Denver, Aurora, Colorado
,
J. Yi
2   Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, University of Colorado Denver, Aurora, Colorado
,
M. Smith
1   Department of Radiology, University of Colorado Denver, Aurora, Colorado
,
Rajan Gupta
1   Department of Radiology, University of Colorado Denver, Aurora, Colorado
› Author Affiliations
Further Information

Publication History

Publication Date:
14 November 2014 (online)

Abstract

Peripheral artery disease (PAD), secondary to atherosclerotic disease, is currently the leading cause of morbidity and mortality in the western world. While PAD is common, it is estimated that the majority of patients with PAD are undiagnosed and undertreated. The challenge to the treatment of PAD is to accurately diagnose the symptoms and determine treatment for each patient. The varied presentations of peripheral vascular disease have led to numerous classification schemes throughout the literature. Consistent grading of patients leads to both objective criteria for treating patients and a baseline for clinical follow-up. Reproducible classification systems are also important in clinical trials and when comparing medical, surgical, and endovascular treatment paradigms. This article reviews the various classification systems for PAD and advantages to each system.

 
  • References

  • 1 Criqui MH, Fronek A, Barrett-Connor E, Klauber MR, Gabriel S, Goodman D. The prevalence of peripheral arterial disease in a defined population. Circulation 1985; 71 (3) 510-515
  • 2 Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999-2000. Circulation 2004; 110 (6) 738-743
  • 3 Norgren L, Hiatt WR, Dormandy JA , et al; TASC II Working Group. Inter-society consensus for the management of peripheral arterial disease. Int Angiol 2007; 26 (2) 81-157
  • 4 Fowkes FGR, Housley E, Riemersma RA , et al. Smoking, lipids, glucose intolerance, and blood pressure as risk factors for peripheral atherosclerosis compared with ischemic heart disease in the Edinburgh Artery Study. Am J Epidemiol 1992; 135 (4) 331-340
  • 5 Newman AB, Sutton-Tyrrell K, Kuller LH. Lower-extremity arterial disease in older hypertensive adults. Arterioscler Thromb 1993; 13 (4) 555-562
  • 6 Olin JW. Masterclass series in peripheral arterial disease: Hypertension and peripheral arterial disease. Vasc Med 2005; 10 (3) 241-246
  • 7 Price JF, Mowbray PI, Lee AJ, Rumley A, Lowe GD, Fowkes FG. Relationship between smoking and cardiovascular risk factors in the development of peripheral arterial disease and coronary artery disease: Edinburgh Artery Study. Eur Heart J 1999; 20 (5) 344-353
  • 8 Rooke TW, Hirsch AT, Misra S , et al; American College of Cardiology Foundation Task Force; American Heart Association Task Force. Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 61 (14) 1555-1570
  • 9 Hirsch AT, Haskal ZJ, Hertzer NR , et al; American Association for Vascular Surgery/Society for Vascular Surgery; Society for Cardiovascular Angiography and Interventions; Society for Vascular Medicine and Biology; Society of Interventional Radiology; ACC/AHA Task Force on Practice Guidelines. ACC/AHA Guidelines for the Management of Patients with Peripheral Arterial Disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Associations for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease)—summary of recommendations. J Vasc Interv Radiol 2006; 17 (9) 1383-1397 , quiz 1398
  • 10 Fontaine R, Kim M, Kieny R. Surgical treatment of peripheral circulation disorders [in German]. Helv Chir Acta 1954; 21 (5–6) 499-533
  • 11 Rutherford RB, Flanigan DP, Gupta SK , et al. Suggested standards for reports dealing with lower extremity ischemia. J Vasc Surg 1986; 4 (1) 80-94
  • 12 Rutherford RB, Baker JD, Ernst C , et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 1997; 26 (3) 517-538
  • 13 Høyer C, Sandermann J, Petersen LJ. The toe-brachial index in the diagnosis of peripheral arterial disease. J Vasc Surg 2013; 58 (1) 231-238
  • 14 Vogelberg KH, Berchtold P, Berger H , et al. Primary hyperlipoproteinemias as risk factors in peripheral artery disease documented by arteriography. Atherosclerosis 1975; 22 (2) 271-285
  • 15 Bollinger A, Breddin K, Hess H , et al. Semiquantitative assessment of lower limb atherosclerosis from routine angiographic images. Atherosclerosis 1981; 38 (3–4) 339-346
  • 16 Bell P, Charlesworth D, DePalma R , et al. The definition of critical ischaemia of a limb. Working party of the International Vascular Symposium. Br J Surg 1982; 69 (S6) S2-S3
  • 17 Jude EB, Oyibo SO, Chalmers N, Boulton AJ. Peripheral arterial disease in diabetic and nondiabetic patients: a comparison of severity and outcome. Diabetes Care 2001; 24 (8) 1433-1437
  • 18 Graziani L, Silvestro A, Bertone V , et al. Vascular involvement in diabetic subjects with ischemic foot ulcer: a new morphologic categorization of disease severity. Eur J Vasc Endovasc Surg 2007; 33 (4) 453-460
  • 19 Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg 2000; 31 (1, Pt 2) S1-S296
  • 20 Hans SS, DeSantis D, Siddiqui R, Khoury M. Results of endovascular therapy and aortobifemoral grafting for Transatlantic Inter-Society type C and D aortoiliac occlusive disease. Surgery 2008; 144 (4) 583-589 , discussion 589–590
  • 21 Pulli R, Dorigo W, Fargion A , et al. Early and long-term comparison of endovascular treatment of iliac artery occlusions and stenosis. J Vasc Surg 2011; 53 (1) 92-98
  • 22 Balzer JO, Gastinger V, Ritter R , et al. Percutaneous interventional reconstruction of the iliac arteries: primary and long-term success rate in selected TASC C and D lesions. Eur Radiol 2006; 16 (1) 124-131
  • 23 Davaine J-M, Quérat J, Guyomarch B , et al. Primary stenting of TASC C and D femoropopliteal lesions: Results of the STELLA register at 30 months. Ann Vasc Surg 2014;
  • 24 Miyamoto N, Kawasaki R, Fukuda T, Yamaguchi M, Sugimura K, Sugimoto K. Endovascular treatment for unilateral chronic total occlusions of the iliac artery categorized as TASC II type D lesions. Surg Today 2014; 1-6
  • 25 Aihara H, Soga Y, Mii S , et al; RECANALISE Registry Investigators. Comparison of long-term outcome after endovascular therapy versus bypass surgery in claudication patients with Trans-Atlantic Inter-Society Consensus-II C and D femoropopliteal disease. Circ J 2014; 78 (2) 457-464
  • 26 Baril DT, Chaer RA, Rhee RY, Makaroun MS, Marone LK. Endovascular interventions for TASC II D femoropopliteal lesions. J Vasc Surg 2010; 51 (6) 1406-1412
  • 27 Sixt S, Krankenberg H, Möhrle C , et al. Endovascular treatment for extensive aortoiliac artery reconstruction: a single-center experience based on 1712 interventions. J Endovasc Ther 2013; 20 (1) 64-73
  • 28 Taurino M, Persiani F, Fantozzi C, Ficarelli R, Rizzo L, Stella N. Trans-Atlantic Inter-Society Consensus II C and D iliac lesions can be treated by endovascular and hybrid approach: a single-center experience. Vasc Endovascular Surg 2014; 48 (2) 123-128
  • 29 Tewksbury R, Pearch B, Redmond K, Harper J, Klein K, Quinn J. Outcomes of infrapopliteal endoluminal intervention for transatlantic intersociety consensus C and D lesions in patients with critical limb ischaemia. ANZ J Surg 2013;
  • 30 Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 1987; 40 (2) 113-141
  • 31 Biancari F, Juvonen T. Angiosome-targeted lower limb revascularization for ischemic foot wounds: systematic review and meta-analysis. Eur J Vasc Endovasc Surg 2014; 47 (5) 517-522
  • 32 Schaper NC. Diabetic foot ulcer classification system for research purposes: a progress report on criteria for including patients in research studies. Diabetes Metab Res Rev 2004; 20 (Suppl. 01) S90-S95
  • 33 Armstrong DG, Lavery LA, Harkless LB. Validation of a diabetic wound classification system. The contribution of depth, infection, and ischemia to risk of amputation. Diabetes Care 1998; 21 (5) 855-859
  • 34 Wagner Jr FW. The dysvascular foot: a system for diagnosis and treatment. Foot Ankle 1981; 2 (2) 64-122
  • 35 Macfarlane R, Jeffcoate W. Classification of diabetic foot ulcers: the S(AD) SAD system. The Diabetic Foot Journal 1999; 2: 123-131
  • 36 Martínez-De Jesús FR. A checklist system to score healing progress of diabetic foot ulcers. Int J Low Extrem Wounds 2010; 9 (2) 74-83
  • 37 Mills Sr JL, Conte MS, Armstrong DG , et al; Society for Vascular Surgery Lower Extremity Guidelines Committee. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg 2014; 59 (1) 220-234 , e1–e2
  • 38 Rondinelli RD, Genovese E, Brigham CR, Association AM . Guides to the Evaluation of Permanent Impairment: American Medical Association; 2008