Indication | Recommendation | Level of evidence |
Claudication: | ||
Class I | EVT is indicated for vocational or lifestyle-limiting disability due to IC if there is reasonable likelihood of symptomatic improvement with EVT and (a) response to exercise or pharmacological therapy is inadequate and/or (b) favourable risk/benefit ratio (eg, focal aortoiliac occlusive disease) | A |
EVT is preferred revascularisation technique for simple iliac and femoropopliteal arterial lesions | B | |
Provisional stent placement in iliac arteries for suboptimal or failed result from balloon dilation | B | |
Stenting is effective as primary therapy for common iliac and external iliac artery stenoses and occlusions | B and C | |
Class IIa | Stents (and other adjunctive techniques such as lasers, cutting balloons, atherectomy devices and thermal devices) can be useful in the femoral, popliteal and tibial arteries for a suboptimal or failed result from balloon dilation | C |
Class III | Primary stent placement is not recommended in the femoral, popliteal, or tibial arteries | C |
EVT is not indicated as prophylactic therapy in a patient who is asymptomatic with lower extremity PAD | C | |
Critical limb ischaemia: | ||
Class I | Inflow lesions should be revascularised first | C |
Outflow revascularisation should be performed when symptoms of CLI or infection persist after inflow revascularisation. | B | |
Class III | EVT is not indicated in patients with severe decrements in limb perfusion (eg, ABI<0.4) in the absence of clinical symptoms of CLI | C |
ABI, ankle–brachial index; ACC, American College of Cardiology; AHA, American Heart Association; CLI, critical limb ischaemia; EVT, endovascular therapy; IC, intermittent claudication; PAD, peripheral arterial disease.