Peripheral arterial disease

Ankle-brachial index (ABI)

This is a ratio of the blood pressure at the ankle compared with the arm while resting:[2]Writing Committee Members; Gornik HL, Aronow HD, Goodney PP, et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. J Am Coll Cardiol. 2024 Jun 18;83(24):2497-604. https://www.sciencedirect.com/science/article/pii/S0735109724003814 http://www.ncbi.nlm.nih.gov/pubmed/38752899?tool=bestpractice.com

• 1.00 to 1.40 is normal

• 0.91 to 0.99 indicates borderline

• ≤0.90 is abnormal

• >1.40 indicates noncompressible vasculature

Society for Vascular Surgery lower extremity threatened limb classification system: risk stratification based on wound, ischemia, and foot infection (WIfI)[50]Mills JL Sr, Conte MS, Armstrong DG, et al. 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 Jan;59(1):220-34;e1-2. https://www.jvascsurg.org/article/S0741-5214(13)01515-2/fulltext http://www.ncbi.nlm.nih.gov/pubmed/24126108?tool=bestpractice.com  

[Figure caption and citation for the preceding image starts]: WoundMills JL Sr, Conte MS, Armstrong DG, et al. 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 Jan;59(1):220-34;e1-2. [Citation ends].[Figure caption and citation for the preceding image starts]: Ischemia (ABI: ankle-brachial index; TP: toe pressure; TcPO2: transcutaneous oximetry)Mills JL Sr, Conte MS, Armstrong DG, et al. 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 Jan;59(1):220-34;e1-2. [Citation ends].[Figure caption and citation for the preceding image starts]: Foot infection (PACO2: partial pressure of arterial carbon dioxide; SIRS: systemic inflammatory response syndrome)Mills JL Sr, Conte MS, Armstrong DG, et al. 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 Jan;59(1):220-34;e1-2. [Citation ends].[Figure caption and citation for the preceding image starts]: Clinical stages (major limb amputation risk) based on Wound, Ischemia, and foot Infection (WIfI) classificationMills JL Sr, Conte MS, Armstrong DG, et al. 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 Jan;59(1):220-34;e1-2. [Citation ends].

TransAtlantic Inter-Society Consensus (TASC): morphological stratification of iliac lesions[51]Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg. 2000 Jan;31(1 Pt 2):S1-296. http://www.ncbi.nlm.nih.gov/pubmed/10666287?tool=bestpractice.com

TASC type A iliac lesions:

• Single stenosis <3 cm of the common iliac artery (CIA) or external iliac artery (EIA) (unilateral/bilateral)

TASC type B iliac lesions:

• Single stenosis 3-10 cm in length, not extending into the common femoral artery (CFA)

• Total of 2 stenoses <5 cm long in the CIA and/or EIA and not extending into the CFA

• Unilateral CIA occlusion

TASC type C iliac lesions:

• Bilateral 5-10 cm long stenosis of the CIA and/or EIA, not extending into the CFA

• Unilateral EIA occlusion not extending into the CFA

• Bilateral CIA occlusion

TASC type D iliac lesions:

• Diffuse, multiple unilateral stenoses involving the CIA, EIA, and CFA (usually >10 cm long)

• Unilateral occlusion involving both the CIA and EIA

• Bilateral EIA occlusions

• Diffuse disease involving the aorta and both iliac arteries

• Iliac stenoses in a patient with an abdominal aortic aneurysm or other lesion requiring aortic or iliac surgery

TASC: morphological stratification of femoropopliteal lesions[51]Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg. 2000 Jan;31(1 Pt 2):S1-296. http://www.ncbi.nlm.nih.gov/pubmed/10666287?tool=bestpractice.com

TASC type A femoropopliteal lesions:

• Single stenosis <3 cm of the superficial femoral artery or popliteal artery

TASC type B femoropopliteal lesions:

• Single stenosis 3-10 cm in length, not involving the distal popliteal artery

• Heavily calcified stenoses ≤3 cm in length

• Multiple lesions, each <3 cm (stenoses or occlusions)

• Single or multiple lesions in the absence of continuous tibial runoff to improve inflow for distal surgical bypass

TASC type C femoropopliteal lesions:

• Single stenosis or occlusion longer than 5 cm

• Multiple stenoses or occlusions, each 3-5 cm in length, with or without heavy calcification

TASC type D femoropopliteal lesions:

• Complete CFA or superficial femoral artery occlusions or complete popliteal and proximal trifurcation occlusions

TASC: morphological stratification of infrapopliteal lesions[52]TASC Steering Committee; Jaff MR, White CJ, Hiatt WR, et al. An update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries: a supplement to the inter-society consensus for the management of peripheral arterial disease (TASC II). Vasc Med. 2015 Oct;20(5):465-78. http://www.ncbi.nlm.nih.gov/pubmed/26268268?tool=bestpractice.com

TASC type A infrapopliteal lesions:

• Single focal stenosis in the target tibial artery ≤5 cm in length, with occlusion of similar or worse severity in the other tibial arteries.

TASC type B infrapopliteal lesions:

• Multiple stenoses, each ≤5 cm in length, or total length ≤10 cm, or single occlusion ≤3 cm in length, with occlusion of similar or worse severity in the other tibial arteries.

TASC type C infrapopliteal lesions:

• Multiple stenoses in the target tibial artery and/or single occlusion with total lesion length >10 cm, with occlusion of similar or worse severity in the other tibial arteries.

TASC type D infrapopliteal lesions:

• Multiple occlusions involving the target tibial artery with total lesion length >10 cm or dense lesion calcification or nonvisualization of collaterals. The other tibial arteries are occluded or have dense calcification.