[Course of peripheral arterial diseases]

During January and November 1983 we examined 230 patients by means of doppler evaluation for suspect of peripheral arterial disease. We identified 105 subjects with peripheral arterial disease. During September and November 1993 we tried to convoke again all 230 subjects. Altogether we followed 215 subjects (95 with peripheral arterial disease and 120 without). Sixty-three patients died and we analysed the cause of death. Forty-seven out of 95 patients (49.5%) with peripheral arterial disease died and only 16 out of 120 subjects (13.3%) without peripheral arterial disease. Twenty-five out of 47 deaths (53.2%) happened among the patients with peripheral arterial disease. Age, severity of peripheral arterial disease (measured by ankle-arm pressure ratio) and the presence of a carotid bruit were associated with death. The natural history of peripheral arterial disease has been characterized by a worsening of the intermittent claudication in 52.1% of patients but only 18.6% presented a progression toward a superior class of the Fontaine classification. In conclusion, the peripheral arterial disease, despite his apparently benign course, represents a clinical event that must not be overlooked, because the risk of cardiovascular mortality is high. The measurement of ankle-arm pressure ratio allows a good definition of the severity of peripheral arterial disease and therefore represents a valid prognostic criterion.