A 65-year-old diabetic man presents with a gangrenous right fifth toe, rest pain, and an ankle-brachial pressure index (ABPI) of 0.35. CTA shows a diffuse infra-popliteal arterial disease with patent anterior tibial and peroneal arteries. What Fontaine stage is this and what is the management goal?
- A Fontaine Stage IIb; supervised exercise programme and antiplatelet therapy
- B Fontaine Stage III; urgent angioplasty of the superficial femoral artery
- C Fontaine Stage IV; primary below-knee amputation
- D Fontaine Stage IV; limb salvage via infrapopliteal bypass or endovascular revascularisation ✓
Explanation
Fontaine staging: I = asymptomatic; IIa = claudication >200 m; IIb = claudication <200 m; III = rest pain; IV = tissue loss (gangrene/ulceration). Rest pain with gangrene is Stage IV critical limb ischaemia (CLI). The management goal is limb salvage through revascularisation (angioplasty with or without stenting for infrapopliteal disease, or distal bypass using autologous vein). Primary amputation is a last resort when revascularisation is impossible or not life-saving. ABPI <0.4 indicates severe ischaemia. The BASIL trial compared bypass surgery vs angioplasty in CLI.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.