Fontaine scheme classification for peripheral arterial disease (PAD)

The Fontaine scheme classifies four stages of peripheral arterial disease (1)

• peripheral arterial disease can be asymptomatic (Fontaine stage I) or symptomatic (Fontaine stages II-IV)

Stage I: asymptomatic

Stage IIa: mild claudication

Stage IIb: moderate to severe claudication

Stage III: ischaemia rest pain

Stage IV: ulceration or gangrene.

• the most common symptom of peripheral arterial disease is intermittent claudication (Fontaine stage II), which is characterised by pain in the legs or buttocks that occurs with exercise and is relieved with rest
• two further stages exist: pain in the extremities at rest (ischaemic rest pain, Fontaine stage III) and necrosis and gangrene (Fontaine stage IV)

Reference:

1. Aboyans V, Ricco JB, Bartelink MEL, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Eur Heart J. 2018 Mar 1;39(9):763-816.