Timely update comes as September marks Peripheral Artery Disease (PAD) Awareness Month
Rosemont, Ill. – September 24, 2025 — The Society for Vascular Surgery (SVS) recently released updated clinical guidelines for the management of intermittent claudication, the most common symptom of peripheral artery disease (PAD). The recommendations are the culmination of a multi-year, multidisciplinary effort and mark the first time SVS has included a formal patient panel during the process of guideline development.
The updated guidelines were published in the August 2025 issue of the Journal of Vascular Surgery, incorporating nearly a decade of new evidence. They are available online here.
PAD affects over 10 million Americans, yet it remains widely underdiagnosed. Intermittent claudication (IC)—pain or cramping while walking that stops when you rest—is not just a nuisance of aging, but a warning sign of a serious vascular condition that can lead to amputation and even death.
By directly involving patients in the guideline development process, SVS ensured that the new guidelines reflect not only the latest evidence but also the values, preferences and experiences of people living with PAD. The patient panel emphasized the importance of clear communication, setting realistic treatment goals and providing support resources beyond the clinic.
“Treatment of patients with IC should be individualized and frequently staged, beginning with education and non-invasive approaches. Patients with IC should understand the relationship between PAD and cardiovascular events and be engaged in the lifestyle modifications and evidence-based medical therapies that are key to risk reduction. Shared decision making on revascularization should be based on symptom severity, comorbid conditions, response to exercise and medications, anatomic pattern of disease, and a full consideration of the risk and benefit for the proposed intervention” said Dr. Michael S. Conte, chair of the guideline writing group and professor of surgery at the University of California, San Francisco.
What the new guidelines recommend
The updated guideline highlights evidence-based approaches to treatment for intermittent claudication. The first step in treatment is education and lifestyle changes — including smoking cessation, controlling risk factors like blood pressure and cholesterol, taking recommended cardioprotective medications and following a structured exercise program. Revascularization (e.g. surgery or angioplasty/stenting) should be considered for patients whose symptoms significantly limit daily life activities despite these measures.
Other key recommendations include:
- Dual pathway antithrombotic therapy—combining low-dose rivaroxaban (2.5 mg twice daily) with aspirin—is suggested for patients with intermittent claudication and high-risk comorbidities such as diabetes, heart failure or polyvascular disease, as well as for those who have undergone revascularization. This approach has been shown to reduce the risk of cardiovascular events, though it carries a modest increase in bleeding risk.
- Supervised exercise therapy (SET) is recommended as the gold standard for improving walking performance. Patients should walk at least three times per week for 12 weeks. For those unable or unwilling to participate in SET, structured home-based walking programs are recommended. Exercise should be continued post-intervention for those who undergo revascularization to maximize functional gain.
- Revascularization should only be considered after conservative measures have failed and symptoms are lifestyle-limiting. Shared decision-making is essential and should include a discussion of potential risks-including mortality, major adverse cardiovascular events and limb complications-as well as expected benefits such as improved mobility and quality of life.
- Infrapopliteal interventions are discouraged in patients with IC due to a lack of evidence supporting their benefit and rising concerns about potential harm.
- When performing endovascular intervention for femoropopliteal lesions longer than 5cm, the use of drug-coated balloons, drug-eluting stents or bare metal stents is recommended over plain balloon angioplasty to reduce the risk of restenosis and reintervention.
The guidelines also identify gaps in current research, including the need for large-scale studies on treatment effectiveness and innovative home-based walking programs.
Raising awareness during PAD Awareness Month
The release of the updated guidelines comes as September marks Peripheral Artery Disease Awareness Month, a time to raise awareness not only among patients but also among the healthcare professionals who care for them. Recent national survey data show that primary care providers rank vascular disease among the top three health crises facing older Americans, yet 80% say they are not confident in recognizing or diagnosing it. In fact, when asked to identify common symptoms — such as difficulty walking or cold feet — only 6% of providers could do so correctly.
SVS is urging clinicians to use PAD Awareness Month as an opportunity to revisit how they identify and manage intermittent claudication and other signs of vascular disease, and to partner closely with vascular surgeons to ensure patients receive timely, evidence-based care.
"The SVS launched its Highway to Health campaign to help raise awareness of vascular disease and facilitate these important discussions between patients and their physicians,” said Dr. William Shutze, former Secretary of the SVS and H2H spokesperson. “The campaign addresses critical awareness gaps by promoting tools like the SVS Strong Vessel Score (a checklist evaluating factors such as diabetes, smoking history, high cholesterol, high blood pressure, and family history) to benchmark personal risk and spark doctor conversations. The campaign also seeks to encourage physicians across specialties to integrate vascular health discussions into routine care, ultimately reducing life-threatening complications like heart attacks, strokes, amputations, and death through early detection and intervention. Supporting resources include videos, checklists, and interactive elements available at YourVascularHealth.org.”
For more information about PAD and its symptoms, visit yourvascularhealth.org.
About SVS
The Society for Vascular Surgery (SVS) seeks to advance excellence and innovation in vascular health through education, advocacy, research, and public awareness. The organization was founded in 1946 and currently has a membership of approximately 6,500. SVS membership is recognized in the vascular community as a mark of professional achievement.
For media inquiries, please contact:
Megan Marcinko
svspress@vascularsociety.org