[The prognosis of intermittent claudication]

Area of Science:

• Vascular Surgery
• Peripheral Artery Disease
• Intermittent Claudication

Context:

• Arteriosclerosis obliterans (ASO) is a significant cause of lower limb ischemia.
• Intermittent claudication, a hallmark symptom of ASO, impacts patient mobility and quality of life.
• Understanding the long-term fate of limbs and lives in claudicant patients is crucial for effective management.

Purpose:

• To evaluate the outcomes of limbs and lives in patients with intermittent claudication due to ASO.
• To compare the efficacy and risks of non-surgical management versus arterial reconstruction.
• To inform treatment strategies for mild intermittent claudication.

Summary:

• A six-year observational study followed 165 patients with intermittent claudication.
• Non-surgical management (Group A) in 87 limbs resulted in 98% limb improvement or stability with no amputations.
• Arterial reconstruction (Group B) in 120 limbs had a 75% success rate but 2.7% amputation rate and 2.1% operative mortality. Five-year graft patency was 82.1% for supra-inguinal and 65.7% for infra-inguinal reconstructions.
• Mortality within 5 years was 30%, primarily from cardiac or cerebrovascular disease.

Impact:

• Non-surgical management is a viable and effective option for mild intermittent claudication, preserving limbs.
• Arterial reconstruction offers benefits but requires careful consideration of risks, graft patency, and patient selection.
• The high mortality from cardiovascular events underscores the importance of managing systemic risk factors in claudicant patients.