Faculty Collaboration Database

Natural history of claudication: long-term serial follow-up study of 1244 claudicants. J Vasc Surg 2001 Dec;34(6):962-70

Date

12/18/2001

Pubmed ID

11743546

DOI

10.1067/mva.2001.119749

Scopus ID

2-s2.0-0035654172 (requires institutional sign-in at Scopus site)   128 Citations

Abstract

OBJECTIVE: The purpose of this study was to delineate the natural history of claudication and determine risk factors for ischemic rest pain (IRP) and ischemic ulceration (IU) among patients with claudication.

METHODS: We prospectively collected data on 1244 men with claudication during a 15-year period, including demographics, clinical risk factors, and ankle-brachial index (ABI). We followed these patients serially with ABIs, self-reported walking distance (WalkDist), and monitoring for IRP and IU. We used Kaplan-Meier and proportional hazards modeling to find independent predictors of IRP and IU.

RESULTS: Mean follow-up was 45 months; statistically valid follow-up could be carried out for as long as 12 years. ABI declined an average of 0.014 per year. WalkDist declined at an average rate of 9.2 yards per year. The cumulative 10-year risks of development of IU and IRP were 23% and 30%, respectively. In multivariate analysis using several clinical risk factors, we found that only DM (relative risk [RR], 1.8) and ABI (RR, 2.2 for 0.1 decrease in ABI) predicted the development of IRP. Similarly, only DM (RR, 3.0) and ABI (RR, 1.9 for 0.1 decrease in ABI) were significant predictors of IU.

CONCLUSION: This large serial study of claudication is, to our knowledge, the longest of its kind. We documented an average rate of ABI decline of 0.014 per year and a decline in WalkDist of 9.2 yards per year. Two clinical factors, ABI and DM, were found to be associated with the development of IRP and IU. Our findings may be useful in predicting the clinical course of claudication.

Author List

Aquino R, Johnnides C, Makaroun M, Whittle JC, Muluk VS, Kelley ME, Muluk SC

Author

Jeffrey Whittle MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Diabetes Complications
Disease Progression
Exercise Test
Follow-Up Studies
Humans
Hypertension
Intermittent Claudication
Leg Ulcer
Male
Middle Aged
Multivariate Analysis
Pain
Pain Measurement
Pennsylvania
Proportional Hazards Models
Rest
Risk Factors
Severity of Illness Index
Smoking
Survival Analysis
Ultrasonography, Doppler
Veterans
Walking