Poor Prognosis in Critical Limb Ischemia Without Pre-Onset Intermittent Claudication

Area of Science:

• Vascular Surgery
• Ischemic Limb Disease
• Patient Outcomes

Background:

• Critical limb ischemia (CLI) can occur without prior symptoms of intermittent claudication (IC).
• The outcomes for CLI patients without a history of IC are not well understood.
• This study investigates the characteristics and prognosis of CLI patients who did not experience IC prior to diagnosis.

Purpose of the Study:

• To compare outcomes between patients with critical limb ischemia (CLI) with and without a history of intermittent claudication (IC).
• To identify unique features and risk factors associated with CLI in patients lacking prior IC symptoms.
• To determine if the absence of IC is an independent predictor of poor outcomes in CLI patients.

Main Methods:

• Retrospective analysis of 225 patients (265 limbs) with CLI, divided into non-IC (142 patients) and IC (83 patients) groups.
• Comparison of comorbid factors, revascularization rates, and clinical outcomes between the two groups.
• Cox regression analysis to identify independent risk factors for amputation-free survival.

Main Results:

• Patients without prior IC were more likely to have diabetes, hypoalbuminemia, advanced disease (Rutherford's classification), and worse ambulatory function.
• A higher proportion of the non-IC group failed arterial revascularization due to disease progression or infection.
• Amputation-free survival was significantly lower in the non-IC group compared to the IC group.

Conclusions:

• Patients presenting with CLI without prior IC symptoms exhibit distinct clinical characteristics.
• The absence of intermittent claudication is an independent risk factor associated with poorer outcomes in critical limb ischemia.
• These findings highlight the need for tailored management strategies for CLI patients without preceding IC.