PVD can be categorized using the Fontaine or Rutherford classification system. Each system grades PVD from no symptoms to major tissue loss and can be used at diagnosis and to evaluate the progression or improvement of symptoms.
Fontaine’s classification of peripheral vascular disease (PVD)
There are five Fontaine stages:
- Stage I: Asymptomatic. Of note: Fontaine stage I does in fact describe patients who are for the most part asymptomatic. Careful history may actually reveal subtle and non-specific symptoms such as paresthesias. Physical examination may reveal cold extremities and other signs of “subclinical” peripheral artery disease. More examples include bruits over blood vessels and lack of normal pulses.
- Stage II: Intermittent claudication. This stage takes into account the fact that patients usually have a very constant distance at which they have pain:
- Stage IIa: Intermittent claudication after more than 200 meters of pain free walking.
- Stage IIb: Intermittent claudication after less than 200 meters of walking
- Stage III: Rest pain. Rest pain is especially troubling for patients during the night. The reason for this is twofold: First, the legs are usually raised up on to a bed at night, thus diminishing the positive effect gravity may have had during the day when the legs were dependent. Second, during the night the lack of sensory stimuli allow patients to focus on their legs.
- Stage IV: Ischemic ulcers or gangrene (which may be dry or humid).
Rutherford‘s classification of peripheral vascular disease (PVD)
A classification introduced by Robert B. Rutherford in 1986 and revised in 1997 consists of four grades and seven categories:
- Grade 0, Category 0: Asymptomatic
- Grade I, Category 1: Mild claudication
- Grade I, Category 2: Moderate claudication
- Grade I, Category 3: Severe claudication
- Grade II, Category 4: Rest pain
- Grade III, Category 5: Minor tissue loss; Ischemic ulceration not exceeding ulcer of the digits of the foot
- Grade IV, Category 6: Major tissue loss; Severe ischemic ulcers or frank gangrene
The TASC (and TASC II) classification suggested PAD treatment by severity of disease seen on angiogram. More recently classifications, such as the Society for Vascular Surgery “Wound, Ischemia and Foot Infection” (WIFI) classification, take into account that ischemia and angiographic disease patterns are not the only determinants of amputation risk.
- Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG; TASC II Working Group., Bell K, Caporusso J, Durand-Zaleski I, Komori K, Lammer J, Liapis C, Novo S, Razavi M, Robbs J, Schaper N, Shigematsu H, Sapoval M, White C, White J, Clement D, Creager M, Jaff M, Mohler E 3rd, Rutherford RB, Sheehan P, Sillesen H, Rosenfield K. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33 Suppl 1:S1-75. [Medline]
- Kullo IJ, Rooke TW. CLINICAL PRACTICE. Peripheral Artery Disease. N Engl J Med. 2016 Mar 3;374(9):861-71. [Medline]
Created: Apr 24, 2017.