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Medical Co-morbidities but Not Interventions Adversely Affect Survival in Patients with Intermittent Claudication
Kenneth Perrone, BA, Marcus R. Kret, MD, Amir F. Azarbal, MD, Erica L. Mitchell, MD, Timothy K. Liem, MD, Gregory J. Landry, MD, Gregory L. Moneta, MD.
Oregon Health & Science University, Portland, OR, USA.
OBJECTIVES: Intermittent claudication (IC) is common and associated with decreased survival. While patients with IC infrequently progress to critical limb ischemia (CLI), many elect to pursue intervention initially or during follow-up. In recent years more patients with IC are being offered intervention. However, controversy exists as to whether intervention in patients with IC adversely impacts survival or limb salvage. The purpose of this study was to characterize patient demographics and co-morbidities with respect to differences in survival and limb salvage among patients who elect no intervention versus those electing immediate or delayed intervention for IC.
METHODS: Patients referred to a university practice for limb ischemia were identified from 2007-2011. Patients with prior lower extremity interventions or CLI were excluded. IC patients were classified according to intervention: no intervention during follow-up (NI), immediate intervention (II) and delayed intervention (DI). Patient demographics, Charlson morbidity index, survival, and reintervention rates were analyzed.
RESULTS: 262 of 1320 patients met inclusion criteria. 30 patients with possible IC were felt to have non-arterial related symptoms. Study patients included 132 with NI, 62 with II, and 38 with DI. DI patients were younger and less frequently diabetic (median age 65.5, 63.5, 58.0; P=.002, diabetes 43.2%, 39.5%, 22.6%, p=.02 for NI, II, and DI respectively). NI patients had higher Charlson comorbity scores (p<.05). Hypertension, hyperlipidemia, and diabetes were associated with decreased survival in all groups (p<.05). Median survival was greatest for DI patients and least for NI patients (NI 92 mos, II 95 mos, DI 143 mos; log-rank =.015). Primary patency of interventions at 1 and 5 years were equal for II and DI patients (1yr: II 80% vs. DI 79%, 5yr: II 45% vs. DI 50%; p=0.9). Re-intervention was common with rates similar between the II and DI groups (p>.05). Four of 38 DI patients required minor amputation for progression to CLI. There were no major amputations in any group.
CONCLUSIONS: Progression to CLI is uncommon in IC, while survival of claudicants is decreased by diabetes, hypertension and hyperlipidemia but not by intervention for IC. Reintervention is common in treated IC patients but no different among those undergoing II and DI. Intervention did not lead to major amputation. II or DI in IC patients does not affect survival or major amputation.
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