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

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%)