This protocol addresses lower limb peripheral arterial disease presenting with intermittent claudication — exertional pain in the calf, thigh, or buttock that is absent at rest and resolves within 10 minutes of stopping activity. The clinical stage falls within Rutherford grade I–III or Fontaine stage IIa and IIb. Diagnosis is based on history, clinical presentation, and thorough vascular examination.
Management follows a stepwise strategy that begins with risk factor modification, best medical treatment, and exercise therapy before any consideration of revascularisation. A supervised exercise programme is established as the primary intervention, supported by systemic cardiovascular risk reduction across multiple modifiable factors.
The complete regimen — therapy selection, sequencing, and monitoring — is available in the full protocol.Improved maximum and pain-free walking distance, better health-related quality of life, and reduced self-reported functional impairment. Cardiovascular risk factor targets are formally reassessed at three to six months.
DOI: 10.1016/j.ejvs.2023.08.067
atherosclerotic lower extremity peripheral arterial disease (PAD, see also section 2.1) falling within the following clinical stages: (1) asymptomatic lower limb PAD (Rutherford grade 0/Fontaine stage I); and (2) intermittent claudication (IC, Rutherford grade I–III/Fontaine stage IIa and IIb).
For patients with intermittent claudication, a stepwise approach is recommended, providing risk factor management, best medical treatment, and exercise therapy as a first step, and revascularisation as a second step in compliant patients with continued disabling limb symptoms.
For patients with intermittent claudication, a supervised exercise programme is recommended as first line therapy to improve maximum and pain free walking distance, health related quality of life, and self reported functional impairment.
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