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Published on: September 22, 2020
The prognosis of non-critical limb ischaemia: a systematic review of population-based evidence
J D Hooi1, H E Stoffers, J A Knottnerus
1Department of General Practice, Maastricht University, The Netherlands. Jurenne.Hooi@HAG.UniMass.NL
Insights
Peripheral arterial occlusive disease (PAOD) affects many elderly individuals. While symptomatic PAOD prognosis is documented, more research is needed on asymptomatic PAOD patients and their cardiovascular risks.
Area of Science:
- Vascular Medicine
- Epidemiology
- Geriatrics
Background:
- Peripheral arterial occlusive disease (PAOD) is a prevalent vascular disorder in the elderly population.
- Understanding the disease course, particularly for non-critical limb ischemia (Fontaine stages I and II), is crucial for general practitioners.
- General practitioners play a vital role in diagnosing and managing PAOD.
Purpose of the Study:
- To synthesize population-based evidence on the clinical course and prognosis of PAOD.
- To identify knowledge gaps regarding asymptomatic PAOD and its long-term outcomes.
Main Methods:
- An extensive literature search identified 16 relevant population-based studies.
- Methodological quality of the included studies was rigorously assessed using eight predefined criteria.
Main Results:
- High-quality studies indicate limited data on the prognosis of asymptomatic PAOD, though these patients share increased cardiovascular risks with symptomatic individuals.
- Symptomatic PAOD (intermittent claudication) prognosis is better understood, with key risk factors including smoking, hypertension, age, and diabetes.
- Claudicants face higher risks of other cardiovascular diseases, leading to increased mortality, primarily from coronary heart disease. Men exhibit higher rates of intermittent claudication and mortality than women.
Conclusions:
- General practitioners are essential for secondary prevention strategies in PAOD management.
- Further research is imperative to elucidate the prognosis and long-term outcomes for patients with asymptomatic PAOD.
Background:
Peripheral arterial occlusive disease (PAOD) is the most common peripheral vascular disorder in the elderly. A clear picture of the disease's course, especially in patients with non-critical limb ischaemia (Fontaine stages I and II), is essential for the general practitioner, who plays a key role in the diagnosis and management of PAOD.
Aim:
To evaluate the population-based evidence on the course and prognosis of PAOD.
Methods:
An exhaustive literature search yielded 16 population-based studies on the prognosis of PAOD. The methodological qualities of the studies were assessed according to eight criteria.
Results:
Thirteen studies of high methodological quality show that data on the course, cardiovascular morbidity, and mortality of asymptomatic PAOD are scarce. Only a small group of asymptomatic patients seem to develop intermittent claudication symptoms. However, asymptomatic patients appear to have the same increased risk for cardiovascular morbidity and mortality when compared with claudicants. No data were available on prognostic factors for intermittent claudication and cardiovascular morbidity in asymptomatic patients. The course, cardiovascular morbidity, and mortality of symptomatic PAOD are better documented. A small group of claudicants experience symptom progression. Smoking, hypertension, increasing age, and diabetes are the most relevant risk factors for intermittent claudication. Claudicants are at a higher risk for developing other cardiovascular diseases, resulting in a significantly increased mortality mainly owing to coronary heart disease. Intermittent claudication and a low ankle-brachial pressure index are significant predictors of mortality. Men had intermittent claudication and symptom progression more often than women. Cardiovascular (co-)morbidity was common in both male and female PAOD patients, but male PAOD patients had a higher mortality compared with female PAOD patients.
Conclusion:
Given the current knowledge on the prognosis of PAOD in the general population, an important task for (secondary) prevention is reserved for the general practitioner. Further research is required to document the course and prognosis of asymptomatic PAOD patients.
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