Abstract:

In 2025， the American Society of Vascular Surgery （SVS） released its first focused update on the 2015 management guidelines for intermittent claudication （IC） in the Journal of Vascular Surgery. This updated guideline set is structured around six key PICO questions， leading to twelve evidence-based recommendations， including two best-practice statements. Significantly， this update is notable because it represents the first incorporation of low-dose rivaroxaban into the management pathway for IC， highlighting the significance of both exercise therapy and pharmacologic treatment as primary strategies. Moreover， the guidelines take a more prudent approach towards indications for revascularization， tibial artery interventions， and the use of drug-coated devices. This article systematically interprets the core updates from the latest guideline text， concentrating on analyzing the strength of the recommendations and the level of evidence backing each suggestion. The objective is to establish a practical framework for clinical decision-making to aid vascular surgeons in their clinical practice.

Key words: intermittent claudication, antithrombotic therapy, exercise therapy, revascularization, clinical practice guideline