Lower-Limb Atherosclerotic Occlusion · Medical vs Endovascular vs Bypass

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Clinical grade (claudication vs CLTI)
   Intermittent claudication or CLTI? Acute ischemia?
   • Intermittent claudication, not adequately treated conservatively → Claudication → exercise + medical
   • Claudication, lifestyle-limiting/conservative failure → Lifestyle-limiting → endovascular/bypass
   • Chronic limb-threatening ischemia CLTI (rest pain/ulcer/gangrene) → CLTI → limb-salvage revascularization
   • Acute limb ischemia (sudden 6 P's) → Acute ischemia → emergency
2. [End] Claudication → exercise + medical
   Intermittent claudication → supervised exercise training + best medical therapy (statin, antiplatelet, BP/glucose control, smoking cessation, cilostazol); most improve walking distance.
3. [End] Lifestyle-limiting → endovascular/bypass
   Lifestyle-limiting/conservative failure → revascularization: focal/aortoiliac → endovascular (balloon/stent); long complex femoropopliteal/multilevel → bypass (autologous great saphenous vein preferred) or endovascular (individualized, per BEST-CLI).
4. [End] CLTI → limb-salvage revascularization
   CLTI (rest pain/tissue loss) → early revascularization for limb salvage (good vein → bypass; or endovascular) + wound care + infection control; unreconstructable/unsalvageable → amputation.
5. [End] Acute ischemia → emergency
   Acute limb ischemia → emergency: anticoagulation + catheter-directed thrombolysis/mechanical thrombectomy or surgical embolectomy/bypass; assess limb viability by Rutherford, irreversible → amputation.

Source guidelines & references

• Lower extremity arterial disease management (ESC/ESVS; SVS; BEST-CLI trial)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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