Intermittent claudication in older patients. Practical treatment guidelines

Area of Science:

• Vascular Medicine
• Geriatrics
• Cardiology

Background:

• Intermittent claudication (IC) prevalence rises with age, often dismissed as normal aging.
• IC, despite a good limb prognosis, is a significant predictor of cardiovascular mortality.
• Early detection of vascular lesions in multiple arterial regions is crucial.

Purpose of the Study:

• To outline a minimal strategy for diagnosing vascular lesions in older patients with IC.
• To define treatment goals for IC in the elderly, focusing on mobility, quality of life, and survival.
• To present practical guidelines for managing IC in older adults.

Main Methods:

• Diagnosis involves assessing walking difficulties and identifying vascular lesions.
• Treatment strategies include lifestyle modifications, exercise programs, and antiplatelet drugs.
• Vasoactive drugs and multifocal arterial evaluation (carotids, coronaries, aorta) are considered, especially with exercise limitations or specific obstructions.

Main Results:

• Femoropopliteal or distal obstructions are present in over 75% of elderly patients with IC.
• Exercise and vasoactive drugs are recommended for femoropopliteal/distal obstructions.
• Iliac lesions necessitate multidisciplinary evaluation and consideration of angioplasty or surgery.

Conclusions:

• Effective IC management in the elderly requires accurate diagnosis and tailored treatment.
• A comprehensive approach addressing vascular risk factors and specific arterial lesions improves outcomes.
• Multidisciplinary assessment is vital for complex cases, particularly those involving iliac artery disease.