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Computerized Dynamic Posturography for Postural Control Assessment in Patients with Intermittent Claudication
Published on: December 11, 2013
The progression rate of peripheral arterial disease in patients with intermittent claudication: a systematic review
Insights
Peripheral arterial disease progression in intermittent claudication patients is likely underestimated. Early identification of high-risk individuals is crucial for timely revascularization and improved limb outcomes.
Area of Science:
- Vascular Medicine
- Cardiovascular Research
- Systematic Review Methodology
Background:
- Intermittent claudication (IC) is a common symptom of peripheral arterial disease (PAD).
- Conservative treatment is standard due to limited evidence for early revascularization, potentially missing opportunities for intervention.
- Understanding PAD progression is key to identifying patients at risk of critical limb ischemia.
Purpose of the Study:
- To systematically review the literature on the progression rate of symptomatic peripheral arterial disease (PAD) in patients with intermittent claudication (IC).
- To evaluate available evidence regarding hemodynamic changes and adverse outcomes in PAD patients.
Main Methods:
- Systematic literature search across multiple databases (PubMed, MEDLINE, Cochrane, etc.) using relevant keywords.
- Inclusion of seven prospective and one retrospective cohort study, with participant numbers ranging from 38 to 1244.
- Data extraction and quality assessment using Cochrane recommendations and PRISMA guidelines.
Main Results:
- Progression rates varied, with yearly ankle-brachial pressure index (ABPI) decreases reported from 0.01 to 0.014 in 21% of participants.
- Quality of evidence was generally low to moderate, primarily due to issues with allocation concealment and selection bias.
- Significant heterogeneity in reported progression rates was observed across studies.
Conclusions:
- The progression of PAD in IC patients may be underestimated in current literature, potentially due to study design limitations.
- Predicting deterioration to critical limb ischemia is challenging due to a lack of robust prognostic evidence.
- Further research is needed to identify high-risk patients for early revascularization and reduce lower limb morbidity.
Background:
Intermittent claudication (IC) is the most common symptom of peripheral arterial disease and is generally treated conservatively due to limited prognostic evidence to support early revascularisation in the individual patient. This approach may lead to the possible loss of opportunity of early revascularisation in patients who are more likely to deteriorate to critical limb ischaemia. The aim of this review is to evaluate the available literature related to the progression rate of symptomatic peripheral arterial disease.
Methods:
We conducted a systematic review of the literature in PubMed and MEDLINE, Cochrane library, Elsevier, Web of Science, CINAHL and Opengrey using relevant search terms to identify the progression rate of peripheral arterial disease in patients with claudication. Outcomes of interest were progression rate in terms of haemodynamic measurement and time to development of adverse outcomes. Two independent reviewers determined study eligibility and extracted descriptive, methodologic, and outcome data. Quality of evidence was evaluated using the Cochrane recommendations for assessing risk of bias and was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Results:
Seven prospective cohort studies and one retrospective cohort study were identified and included in this review with the number of participants in each study ranging from 38 to 1244. Progression rate reports varied from a yearly decrease of 0.01 in ankle-brachial pressure index (ABPI) to a yearly decrease ABPI of 0.014 in 21% of participants. Quality of evidence ranged from low to moderate mostly due to limited allocation concealment at recruitment and survival selection bias.
Conclusions:
Progression of PAD in IC patients is probably underestimated in the literature due to study design issues. Predicting which patients with claudication are likely to deteriorate to critical limb ischaemia is difficult since there is a lack of evidence related to lower limb prognosis. Further research is required to enable early identification of patients at high risk of progressing to critical ischaemia and appropriate early revascularisation to reduce lower limb morbidity.
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