Natural history of stenosis in the iliac arteries in patients with intermittent claudication undergoing clinical treatment.
OBJECTIVE
Inspite of the long experience with the treatment of intermittent claudication, little is known about the natural history of stenotic lesions in the iliac segment. With the advent of endovascular treatment, this knowledge has become important.


METHODS
Fifty-two stenosis, diagnosed using arteriography, in 38 claudicant patients were analyzed. After a minimum time interval of 6 months, a magnetic resonance angiography was performed to determine whether there was arterial occlusion. The primary factors that could influence the progression of a stenosis were analyzed, such as risk factors (smoking, hypertension, diabetes, sex, and age), compliance with clinical treatment, initial degree of stenosis, site of the stenosis, and length of follow-up.


RESULTS
The average length of follow-up was 39 months. From the 52 lesions analyzed, 13 (25%) evolved to occlusion. When occlusion occurred, there was clinical deterioration in 63.2% of cases. This association was statistically significant (P = .002). There was no statistically significant association of the progression of the lesion with the degree or site of stenosis, compliance with treatment, or length of follow-up. Patients who evolved to occlusion were younger (P = .02). The logistic regression model showed that the determinant factors for clinical deterioration were arterial occlusion and noncompliance with clinical treatment.


CONCLUSIONS
The progression of a stenosis to occlusion, which occurred in 25% of the cases, caused clinical deterioration. Clinical treatment was important, but it did not forestall the arterial occlusion. Prevention of occlusion could be achieved by early endovascular intervention or with the development of drugs that might stabilize the atherosclerotic plaque.
Ferrari
Fernando Bocchino
FB
Department of Surgery and Division of Vascular Surgery, Hospital das Clínicas, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
Wolosker
Nelson
N
Rosoky
Ruben Aizyn
RA
D'Ippolito
Giuseppe
G
Wolosker
Angela Maria Borri
AM
Puech-Leão
Pedro
P
D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D007383:Intermittent Claudication / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D016015:Logistic Models; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012307:Risk Factors; D016312:Treatment Refusal