VASCULAR: Natural History of ATH LL PAD Syndrome (50 years and older)

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Why is there symptomatic stabilisation in patients with intermittent claudication?

1. Development of collaterals 2. Metabolic adaptation of ischaemic muscle 3. Patient alters gait to favour non-ischemic muscle groups

What is the proportion of patients with intermittent claudication that will significantly deteriorate?

1/4

What is considered low ankle pressure?

40-60mmHg

What is the best predictor of deterioration of PAD (i.e. need for arterial surgery/major amputation) in patients with intermittent claudication?

ABI < 0.5

1 year outcomes of patients with critical limb ischaemia

Alive with two limbs (45%) Amputation (30%) Mortality (25%)

Initial clinical presentation

Asymptomatic PAD (20-50%) Other leg pain (30-40%) Typical claudication (10-35%) Critical limb ischaemia (1-3%)

Causes of mortality

CV causes 75% Non-CV causes 25%

5 year outcomes of patients with asymptomatic PAD, other leg pain or typical claudication

Limb morbidity CV morbidity and mortality

CV morbidity and mortality

Non-fatal cardiovascular event (MI or stroke) 20% Mortality 10-15%

What is the concern in patients with low ankle pressure?

Risk of progression to severe ischemia or actual limb loss is 8.5% per year

Limb morbidity

Stable claudication (70-80%) Worsening claudication (10-20%) Critical limb ischaemia (5-10%)

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