Outcome of conservative therapy of patients with severe intermittent claudication.
BACKGROUND
Intermittent claudication due to peripheral artery disease (PAD) can be treated conservatively, or by revascularization.


OBJECTIVE
To assess the short-term outcome of conservatively-treated claudicants, and determine predictors for clinical improvement. Design. A retrospective cohort study.


METHODS
We evaluated Fontaine stage, walking distance and ankle brachial index (ABI) at baseline and after median 9 months (interquartile range (IQR) 6-24) in 181 patients with severe claudication.


RESULTS
We found clinical improvement by at least one Fontaine stage in 38 patients (21%) with an increased walking distance from baseline median 100 m (IQR 50-150) to follow-up median 650 m (IQR 300 to unlimited; p<0.001), but without changes in ABI (median 0.57, IQR 0.48-0.73 vs. median 0.54, IQR 0.45-0.81; p=0.10). One hundred and thirty-eight patients (76%) remained clinically and hemodynamically stable. A worsening of the clinical stage but without amputation was recorded in five patients (3%). Female gender (hazard ratio (HR) 0.51, p=0.052), diabetes (HR 0.35, p=0.020), and baseline ABI below 0.44 (HR 0.31, p=0.019) were associated with a reduced probability of clinical improvement.


CONCLUSIONS
Certain patients with intermittent claudication show substantial clinical improvement with conservative medical therapy, despite any lack of hemodynamic improvement. Given the low number of patients with clinical deterioration in the short term, primarily conservative therapy should be the preferred initial option for most claudicants.
Amighi
J
J
Department of Angiology, Vienna General Hospital, Medical School, Vienna, Austria.
Sabeti
S
S
Schlager
O
O
Francesconi
M
M
Ahmadi
R
R
Minar
E
E
Schillinger
M
M
D000368:Aged; D015331:Cohort Studies; D003925:Diabetic Angiopathies / Q000628:therapy; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D016138:Walking