Related Experiment Video
Updated: Jun 12, 2025
Computerized Dynamic Posturography for Postural Control Assessment in Patients with Intermittent Claudication
Published on: December 11, 2013
Rate and Predictors of Disease Progression in Patients with Conservatively Managed Intermittent Claudication: A
Joseph Louis Jervis Froud1, Madeleine Landin1, Arsalan Wafi2
1Academic Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Insights
Progression from intermittent claudication (IC) to chronic limb-threatening ischemia (CLTI) is poorly understood. Diabetes, renal failure, and smoking are key predictors, but evidence quality is low.
Area of Science:
- Vascular Medicine
- Epidemiology
- Systematic Review
Background:
- Intermittent claudication (IC) affects 4.5% of the UK population.
- Progression to chronic limb-threatening ischemia (CLTI) carries a significant health burden.
- The natural history of conservatively managed IC is not well-described.
Purpose of the Study:
- To examine the rate of progression from IC to CLTI.
- To identify predictors of progression in conservatively managed IC patients.
Main Methods:
- Systematic review of 9 studies (4,115 patients) using major databases.
- Included adult patients with IC managed conservatively.
- Analyzed progression rates and predictors via univariate and multivariate analyses.
Main Results:
- Progression to CLTI ranged from 1.1% to 36.7% across studies (mean follow-up 5.4 years).
- Significant predictors of progression identified: advanced age, diabetes, hemodialysis, smoking, LDL, HbA1c, and baseline ischemia severity.
- Diabetes, smoking, and hemodialysis were significant in multivariate analysis.
Conclusions:
- Diabetes, renal failure, and smoking are significant predictors of peripheral arterial disease (PAD) progression.
- Evidence quality and data heterogeneity limit definitive conclusions on progression rates.
- Further prospective studies are needed to guide personalized management of IC.
Background:
Intermittent claudication (IC) is a common pathology, affecting 4.5% of the United Kingdom population, and is associated with significant health burden if disease progresses to chronic limb-threatening ischemia (CLTI). The natural history of conservatively managed IC remains poorly described, and this study aimed to examine the rate and predictors of progression from IC to CLTI.
Methods:
Systematic review (PROSPERO ID: CRD42023401259) in accordance with Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines of available literature using Scopus, World of Science, Medline, Embase, and CINAHL databases. Adult patients with IC managed conservatively were included. Progression rate was defined as percentage of IC patients developing CLTI at follow-up. Predictors identified from univariate and multivariate analyses were included. A quantitative synthesis was planned if studies depicted homogeneity.
Results:
Search terms yielded 6,404 unique reports. Nine studies (7 retrospective and 2 prospective cohorts) on a total of 4,115 patients were included in the primary synthesis. Women constituted 22.7% on average (0-30.1%) of patients included within studies. All included studies were nonrandomized cohort designs with expected limitations in terms of determining causal effect. The risk of bias was assessed as "moderate" in 5, and "serious" in 4 of the 9 included studies. 1.1-36.7% of claudicants from studies included developed CLTI by end of follow-up (mean 5.4 ± 2.72 years). A pooled progression rate of 15.26% at maximal (10 years) follow-up did not reach significance (P = 0.67) in meta-analysis and is likely unreliable, demonstrating 99% heterogeneity (P < 0.01). Predictors of progression were advanced age, diabetes, hemodialysis, smoking, serum low-density lipoprotein, HbA1c, and baseline severity of ischemia (Ankle-brachial index, Toe-brachial index and claudication distance) in univariate analysis. Diabetes, smoking and hemodialysis were predictors of progression in multivariate analysis. Only three studies investigating biomarkers of peripheral arterial disease (PAD) progression were found.
Conclusions:
Diabetes, renal failure, and smoking are significant predictors of PAD progression. Poor quality evidence and data heterogeneity preclude conclusive estimates of progression rates. Women are underrepresented among studies. Future structured, prospective prognostic studies addressing the progression of conservatively managed IC are needed to inform personalized management strategies.
More Related Videos
07:25Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
08:05Occlusion of the Great and Small Saphenous Vein Using Copolymeric Glue Based on N-Butyl Cyanoacrylate and Methacryloxy Sulfolane
Published on: December 9, 2022
Related Concept Videos
01:27Peripheral Artery Disease III: Interprofessional Care
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:26Peripheral Artery Disease IV: Nursing Management
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:27Atherosclerosis II: Clinical manifestations and prevention
01:30Peripheral Artery Disease I: Introduction