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Realistic expectations for the patient with intermittent claudication.
D S O'Riordain1, J A O'Donnell
1University Department of Surgery, University College and Regional Hospital, Cork, Ireland.
The British Journal of Surgery
|July 1, 1991
Summary
Intermittent claudication patients with low ankle-brachial pressure index (ABPI) face high mortality risk, primarily from cardiovascular disease. Aggressively managing atherosclerotic risk factors is crucial for improving survival in this high-risk group.
Area of Science:
- Vascular Medicine
- Cardiology
- Epidemiology
Background:
- Intermittent claudication is a common symptom of peripheral artery disease.
- Understanding its natural history is vital for patient management and risk stratification.
- Cardiovascular events are the leading cause of mortality in patients with intermittent claudication.
Purpose of the Study:
- To investigate the long-term natural history of intermittent claudication.
- To identify prognostic factors for mortality and disease progression.
- To assess the role of ankle-brachial pressure index (ABPI) in risk stratification.
Main Methods:
- A prospective cohort study followed 112 patients with intermittent claudication for at least 5 years.
- Mortality rates, causes of death, and disease progression were recorded.
- Ankle-brachial pressure index (ABPI) was measured at baseline and correlated with outcomes.
Main Results:
- 33% of patients died during the study; myocardial infarction and cerebrovascular disease were the most common causes.
- Mortality rates at 2, 5, and 8 years were 8%, 23%, and 40% respectively.
- A baseline ABPI < 0.5 was strongly associated with significantly higher mortality (P < 0.0001).
- Among survivors, 21% experienced worsening claudication and 13% progressed to critical ischemia.
- Eight patients required arterial bypass, and four limbs were lost.
Conclusions:
- Ankle-brachial pressure index (ABPI) effectively identifies a subgroup of intermittent claudication patients at very high risk of death.
- This high-risk subgroup predominantly succumbs to coronary and/or cerebral pathology.
- An aggressive approach focusing on atherosclerotic risk factor modification, not just peripheral vascular issues, may enhance survival in these patients.