Fontaine Stage IIb
A patient with moderate to severe claudication and pain-free walking distance (PFWD) less than 200 meters is classified as Fontaine stage IIb. 1
Classification Framework
The Fontaine classification system divides peripheral arterial disease into four main stages, with stage II subdivided based on walking distance 1:
- Stage I: Asymptomatic 1
- Stage IIa: Claudication at walking distances >200 meters 1
- Stage IIb: Claudication at walking distances <200 meters 1
- Stage III: Rest pain 1
- Stage IV: Ulceration or gangrene 1
Key Distinguishing Feature
The 200-meter threshold is the critical dividing line between mild claudication (Stage IIa) and moderate to severe claudication (Stage IIb). 1 This specific distance cutoff is explicitly defined in the Fontaine classification and corresponds to Rutherford categories 2 and 3 (moderate and severe claudication) 1.
Clinical Correlation
The American Heart Association notes that patients in Fontaine stage IIb experience pain during less strenuous activities such as walking, with the pain typically occurring one level distal to where the arterial obstruction is located 1. At this stage, the claudication may lead to considerable functional limitations in daily life 1.
Relationship to Rutherford Classification
While the Fontaine classification uses the 200-meter walking distance as the specific cutoff, the Rutherford classification does not specify exact distances but categorizes severity as mild (category 1), moderate (category 2), or severe (category 3) claudication 1. The ACC/AHA guidelines note that the 200-meter distance delineation mentioned in the Fontaine classification helps distinguish between these severity levels 1.
Treatment Implications
Patients with Fontaine stage IIb should receive maximal medical therapy as first-line treatment, including guideline-directed pharmacotherapy and supervised exercise therapy, before considering revascularization 2. The European Society of Cardiology recommends that after a 3-month period of optimal medical therapy and exercise therapy, quality of life assessment should guide decisions about potential revascularization 1.
Answer: B. IIb