Absence of Preceding Intermittent Claudication and its Associated Clinical Freatures in Patients with Critical Limb Ischemia.
OBJECTIVE
The current study investigated how prevalent the absence of a prior history of intermittent claudication would be in patients with critical limb ischemia (CLI) and examined the associated clinical features.


METHODS
We used a database of 559 Japanese CLI patients participating in a multicenter prospective study. A history of intermittent claudication prior to CLI onset was surveyed at registration. The 95% confidence interval (CI) of its prevalence was calculated using the Clopper-Pearson method. Logistic regression analysis was performed to assess the association between the clinical features and the absence of preceding intermittent claudication.


RESULTS
The study subjects were 73±10 years old and 67% were male. Tissue loss occurred in 82% of this population. The prevalence of the absence of prior intermittent claudication was 50% [95% CI: 46-55%]. In multivariate logistic regression analysis, a non-ambulatory status, diabetes mellitus, and regular dialysis were significantly and independently associated with the lack of a prior history of intermittent claudication (all p＜0.05). Indeed, the presence of these features was associated with a higher prevalence of the lack of the history. Regular dialysis, but not non-ambulatory status or diabetes mellitus, lost its statistical significance after further adjustment for the presence of isolated infrapopliteal lesions, whereas the presence of isolated infrapopliteal lesions itself was significantly associated with a lack of prior intermittent claudication.


CONCLUSIONS
The absence of a prior history of intermittent claudication was prevalent in CLI patients. Patients with a non-ambulatory status, diabetes mellitus, and regular dialysis were more likely to lack a prior history of intermittent claudication.
Department of Metabolic Medicine, Osaka University Graduate School of Medicine.
Mitsuyoshi
M
Takahara
Osamu
O
Iida
Yoshimitsu
Y
Soga
Akio
A
Kodama
Nobuyoshi
N
Azuma
D000368:Aged; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000150:complications; D007511:Ischemia / Q000503:physiopathology; D007866:Leg / Q000098:blood supply*; D016015:Logistic Models; D008297:Male; D051346:Mobility Limitation; D011446:Prospective Studies; D006435:Renal Dialysis