# Fontaine — Fontaine classification of peripheral arterial disease

> Stages chronic limb ischemia by symptoms.

**Situação:** vigente · **Órgão:** Vascular · **Órgão emissor:** Vascular consensus · **Versão:** 1954 · **Ano:** 1954

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: Angiography
- Fonte primária: Fontaine R; Rutherford RB. Classification of chronic limb ischemia (Fontaine and Rutherford) (1954) — https://en.wikipedia.org/wiki/Peripheral_artery_disease
- Última verificação: 2026-06-26
- Última checagem: 2026-06-26

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| I | Stage I, asymptomatic | Asymptomatic stage — peripheral arterial disease is present but the patient has no symptoms. | Cardiovascular risk-factor management: smoking cessation, statin and antiplatelet therapy, and control of diabetes/hypertension; no revascularization for the asymptomatic limb itself. | Up to ~50% of people with PAD are asymptomatic; even without limb symptoms, PAD marks elevated cardiovascular risk (stroke and myocardial infarction). | Wikipedia 'Peripheral artery disease', Classification section (Fontaine stage I 'asymptomatic') and Treatment/Prognosis sections (risk-factor management; ~50% asymptomatic; elevated stroke/MI risk). | ✓ |
| IIa | Stage IIa, mild claudication | Mild intermittent claudication — claudication pain that comes on after walking more than 200 metres. | Smoking cessation and supervised exercise therapy (treadmill walking ~30-60 min, at least 3x/week) plus risk-factor control; first-line for claudication, with revascularization usually reserved for lifestyle-limiting or refractory symptoms. | Claudication is relatively benign for the limb — over ~5 years only ~7% undergo bypass, ~4% major amputation, ~16% worsen — but systemic risk is high (estimated ~30% 5-year mortality from cardiovascular events). | Wikipedia 'Peripheral artery disease', Classification section (Fontaine IIa, claudication >200 m) and Treatment/Prognosis sections (supervised exercise 30-60 min 3x/week; 7% bypass, 4% amputation, 16% worsening; ~30% 5-year mortality). | ✓ |
| IIb | Stage IIb, moderate to severe claudication | Moderate-to-severe intermittent claudication — claudication pain that comes on after walking less than 200 metres. | As for IIa — smoking cessation, supervised exercise therapy and risk-factor control are first-line; revascularization (endovascular or bypass) is considered for lifestyle-limiting or exercise-refractory short-distance claudication. | Still a claudication (non-limb-threatening) stage with limb-outcome and ~30% 5-year cardiovascular mortality figures shared with IIa, though shorter pain-free distance reflects more severe disease. | Wikipedia 'Peripheral artery disease', Classification section (Fontaine IIb, claudication <200 m) and Treatment/Prognosis sections (exercise therapy/smoking cessation first-line; claudication-cohort outcomes and ~30% 5-year mortality). | ✓ |
| III | Stage III, rest pain | Ischemic rest pain — pain in the limb at rest, without exertion. | Part of chronic limb-threatening (critical) ischemia: revascularization is appropriate (endovascular or surgical bypass, with bypass recommended where life expectancy exceeds ~2 years), alongside analgesia and risk-factor management. | Critical limb ischemia / limb-threat category — clear risk of limb loss if adequate perfusion is not re-established. | Wikipedia 'Peripheral artery disease', Classification section (Fontaine III 'rest pain') and Treatment sections on chronic limb-threatening/critical limb ischemia (revascularization, bypass if life expectancy >2 years; risk of limb loss). | ✓ |
| IV | Stage IV, ulceration or gangrene | Tissue loss — ulceration or gangrene of the affected limb. | Critical limb ischemia with tissue loss: urgent revascularization to salvage the limb plus wound care; amputation may be required when gangrene is established or revascularization fails. | Highest-risk stage for limb loss — established gangrene/tissue death and infection often necessitate amputation. | Wikipedia 'Peripheral artery disease', Classification section (Fontaine IV 'ulcers or gangrene') and Treatment sections (revascularization vs amputation; amputation when gangrene established). | ✓ |

### Citações por categoria
- **I**: Fontaine R; Rutherford RB. Classification of chronic limb ischemia (Fontaine and Rutherford) (1954) — https://en.wikipedia.org/wiki/Peripheral_artery_disease · Wikipedia 'Peripheral artery disease', Classification section (Fontaine stage I 'asymptomatic') and Treatment/Prognosis sections (risk-factor management; ~50% asymptomatic; elevated stroke/MI risk).
- **IIa**: Fontaine R; Rutherford RB. Classification of chronic limb ischemia (Fontaine and Rutherford) (1954) — https://en.wikipedia.org/wiki/Peripheral_artery_disease · Wikipedia 'Peripheral artery disease', Classification section (Fontaine IIa, claudication >200 m) and Treatment/Prognosis sections (supervised exercise 30-60 min 3x/week; 7% bypass, 4% amputation, 16% worsening; ~30% 5-year mortality).
- **IIb**: Fontaine R; Rutherford RB. Classification of chronic limb ischemia (Fontaine and Rutherford) (1954) — https://en.wikipedia.org/wiki/Peripheral_artery_disease · Wikipedia 'Peripheral artery disease', Classification section (Fontaine IIb, claudication <200 m) and Treatment/Prognosis sections (exercise therapy/smoking cessation first-line; claudication-cohort outcomes and ~30% 5-year mortality).
- **III**: Fontaine R; Rutherford RB. Classification of chronic limb ischemia (Fontaine and Rutherford) (1954) — https://en.wikipedia.org/wiki/Peripheral_artery_disease · Wikipedia 'Peripheral artery disease', Classification section (Fontaine III 'rest pain') and Treatment sections on chronic limb-threatening/critical limb ischemia (revascularization, bypass if life expectancy >2 years; risk of limb loss).
- **IV**: Fontaine R; Rutherford RB. Classification of chronic limb ischemia (Fontaine and Rutherford) (1954) — https://en.wikipedia.org/wiki/Peripheral_artery_disease · Wikipedia 'Peripheral artery disease', Classification section (Fontaine IV 'ulcers or gangrene') and Treatment sections (revascularization vs amputation; amputation when gangrene established).

## Referências cruzadas
- _fronteira compartilhada_ → [Rutherford — Rutherford classification of peripheral arterial disease](https://radcommons.laudos.ai/systems/rutherford-pad.md) — Two staging systems for chronic limb ischemia.


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