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Fate of the patient with chronic leg ischaemia. A review article
J Dormandy1, M Mahir, G Ascady
1St. Georges' Hospitals, London, U.K.
Insights
Peripheral artery disease significantly increases mortality risk in men with leg ischemia, primarily from heart attacks and strokes. Understanding claudication incidence is crucial for managing this vascular condition.
Area of Science:
- Vascular Medicine
- Epidemiology
Background:
- Limited data exists on the incidence of claudication and outcomes for patients with chronic leg ischemia not undergoing surgery.
- Surgical treatments for leg ischemia are well-documented, but non-surgical patient cohorts are understudied.
Purpose of the Study:
- To review the available literature on the incidence of intermittent claudication and the prognosis of patients with chronic leg ischemia.
- To highlight the mortality risks and causes of death in individuals with leg ischemia.
Main Methods:
- Literature review of studies on leg ischemia, claudication, and patient outcomes.
- Analysis of incidence rates and mortality data from existing research.
Main Results:
- Intermittent claudication affects 1.5% of men under 49 and 5% over 50; asymptomatic disease is more common.
- Men with leg ischemia have 2-3 times higher mortality within 5 years, mainly from myocardial ischemia (50%), stroke (15%), and abdominal vascular disease (10%).
- Women experience less severe leg ischemia, and 25% of deaths are unrelated to circulation.
Conclusions:
- Chronic leg ischemia significantly elevates mortality risk, predominantly due to cardiovascular events.
- Further research is needed on the incidence of non-fatal myocardial infarction and stroke in this patient population.
Abstract:
Much has been published on the surgical treatment of leg ischaemia but relatively little is known about the incidence of claudication and the fate of the majority of patients presenting with chronic leg ischaemia who never come to surgery. A review of the available literature suggests the following conclusions: (1) about 1.5% of men under 49 and 5% of men over 50 will develop symptoms of intermittent claudication. The incidence of asymptomatic arterial disease is much higher; (2) the incidence of claudication in women is only slightly less, but the local disease follows a more benign course; (3) compared to the general population of comparable age the mortality of men presenting with chronic leg ischaemia is two to three times higher after 5 years; (4) about 50% of deaths will be due to myocardial ischaemia, 15% to stroke and 10% to vascular disease in the abdomen. In only 25% will the principal cause of death be unconnected with the circulation; (5) there is virtually no reliable information available at the moment on the incidence of non-fatal myocardial infarction or stroke in these patients.