Updated Clinical and Radiological Classification of Lower Limb Atherosclerotic Disease

Lower limb atherosclerotic disease has classically been classified as acute or chronic; however, this is an evolving process that has a wide spectrum of clinical and imaging aspects. Owing to the evolvement of endovascular and imaging techniques, we have now garnered new information regarding the pathophysiology and behavior of atherosclerotic disease, also in response to endovascular and surgical techniques. Clinical presentation can actually be classified according to the time of presentation, ranging from acute (<2 weeks) and subacute (from 2 weeks to 3 months) to chronic (over 3 months) and acute/subacute on underlying chronic disease. Imaging characteristics such as the presence of thrombus, number of collaterals, and target vessel wall features may help in defining the correct type of atherosclerotic lesion, triggering the appropriate treatment strategy. Clinical and imaging characteristics of those different stages are complex and not systematically addressed by current guidelines, that do not show any specific recommendations for imaging pathways/characteristics or treatment. This review illustrates the clinical and imaging characteristics of the different stages of lower limb atherosclerotic disease and related treatment options.