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Intermittent claudication. The natural history
1Division of General Internal Medicine, Northwestern University Medical School, Chicago, Illinois, USA.
Insights
Patients with intermittent claudication often have underlying cardiovascular disease, increasing their risk of adverse events. Careful management and smoking cessation are crucial for improving outcomes in these patients.
Area of Science:
- Vascular Medicine
- Cardiology
- Public Health
Background:
- Intermittent claudication is common in lower extremity atherosclerotic disease.
- Patients with claudication face elevated risks of cardiovascular events due to coexisting conditions.
Purpose of the Study:
- To review management strategies for intermittent claudication.
- To highlight the importance of considering associated cardiovascular disease.
- To emphasize patient selection for interventions and lifestyle modifications.
Main Methods:
- Literature review of studies on intermittent claudication.
- Analysis of risk factors and outcomes in affected patients.
- Evaluation of current treatment approaches and evidence gaps.
Main Results:
- Lower extremity morbidity is generally low, but cardiovascular risk is high.
- Limited data exists for routine coronary artery disease work-up in conservative management.
- Smoking cessation significantly reduces adverse cardiovascular and lower extremity outcomes.
Conclusions:
- Clinicians must integrate cardiovascular risk assessment into intermittent claudication management.
- Careful selection for lower extremity interventions is warranted.
- Further research is needed on functional outcomes across treatment strategies.
Abstract:
Intermittent claudication is a relatively common disorder, present in a subset of patients with lower extremity atherosclerotic disease. Although lower extremity morbidity rates are low, patients with claudication frequently have coexistent cardiovascular disease and are at significantly increased risk of adverse cardiovascular events. Data to support work-up for concomitant coronary artery disease in conservatively managed patients are not available; however, clinicians should consider the high prevalence of coronary artery disease when developing management strategies. Patients should be carefully selected for lower extremity interventional management given the generally benign lower extremity prognosis. Tobacco smokers should be urged to quit, owing to their higher rate of lower extremity and cardiovascular adverse outcomes. Functional outcomes after various treatment strategies have not yet been sufficiently studied in the claudicant.