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Objectives: Although patients with peripheral vascular disease (PAD) commonly present with lower extremity pain, some are asymptomatic, possibly secondary to neuropathy, debility, or a sedentary lifestyle. The aim of our study was to compare the outcomes of patients with asymptomatic, severe PAD to patients with severe PAD with claudication.
Methods: Patients with PAD, identified by lower extremity duplex examination between 2008 and 2010, were studied. Only patients with severe hemodynamic evidence of PAD [ankle-brachial index (ABI) <0.5 or toe pressure (TP) <50 mm HG)] were included. Long-term outcomes of overall survival, amputation-free survival (AFS), limb salvage, re-vascularization, and progression (or occurrence) of symptoms were examined using Kaplan-Meier Life-Table analysis with log rank testing, as well as multivariable Cox Proportional Hazard models.
Results: A total of 612 limbs in 470 patients were identified. These patients were separated into 252 patients (with 336 limbs) who had claudication and 220 patients (with 276 limbs) who were asymptomatic. Analysis over a mean follow up of 732 +802 days showed longer overall survival, increased limb salvage, and higher AFS in the claudication group compared to the asymptomatic group (p<0.0001). Overall five-year survival was 0.70 in the claudication group and 48% in the asymptomatic group [adjusted HR 1.83 (1.33, 2.51); p<0.0001]. Five-year limb salvage was higher in the claudicant group versus the asymptomatic group [98% vs. 92%, adjusted HR 3.75 (1.09, 12.85), p=0.04]. Five-year AFS was 59% in the claudication group and 30% in the asymptomatic group [adjusted HR 1.91 (1.46, 2.50); p<0.0001]. Overall symptom progression at 5 years was 38% among claudicants and 47% among asymptomatic patients [adjusted HR 1.72 (1.14, 2.61); p = 0.001]. Despite the increased rate of symptom progression, the asymptomatic group had a significantly lower rate of vascular intervention.
Conclusions: Patients with asymptomatic, severe PAD had worse overall survival, limb salvage, and AFS when compared to patients who present with severe PAD and claudication. Asymptomatic patients also demonstrate a higher rate of symptom progression when compared to claudicants but have a lower rate of revascularization procedures. Further research is needed to determine specific causes of increased mortality and limb loss in patients with asymptomatic, severe PAD.