title: Understanding Patient Acceptance of Risk with Treatment Options for Intermittent Claudication.
abstract: BACKGROUND
  Intermittent claudication has a major impact on the quality of life and functional ability of the patient. However, when treating these patients, management is largely influenced by vascular surgeons' perceptions of risk. There is little information available regarding the level of risk that patients perceive to be acceptable, when considering complications of treatment. This study investigates patients' acceptance of risk associated with current management options for intermittent claudication and explores factors associated with greater risk acceptance.
  
  
  METHODS
  Patients with confirmed intermittent claudication presenting to vascular clinic and supervised exercise classes were surveyed in a single-center prospective study. A standard gamble-type method was used to measure patients' acceptance of risk associated with medical treatment, angioplasty, and surgical bypass. Level of risk acceptance was correlated to patient factors.
  
  
  RESULTS
  Fifty patients were surveyed; 74% were male, median age was 68 years (interquartile range [IQR] 59-74), maximal walking distance was 100 m (IQR 70-200), and ankle-brachial pressure index was 0.65 (IQR 0.60-0.78). Median risk acceptance for treatment failure was 70% for medical treatment, 50% for angioplasty, and 40% for surgical bypass. Median risk acceptance for major amputation and death was 0% for all 3 management options. Claudicants with maximal walking distance <100 m accepted higher risk of treatment failure (P = 0.0005 for medical treatment, P = 0.0038 for angioplasty), and death with medical treatment (P = 0.0009). There was no significance between claudication distance and risk acceptance of major amputation with any treatment modality or death with angioplasty or surgical bypass. There was no significant correlation among level of risk acceptance and age, gender, or diabetic status.
  
  
  CONCLUSIONS
  Claudicants are prepared to accept significant risk of treatment failure, in order to gain benefit, but regardless of claudication distance, patients have low acceptance of the risk of amputation or death. Patient acceptance of risk should be considered when planning management.
authors.affiliation: Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK; University Department of Surgery, University of Southampton, Southampton General Hospital, Southampton, UK.
authors.forename: Abigail H M
authors.initials: AHM
authors.lastname: Morbi
authors.affiliation: University Department of Surgery, University of Southampton, Southampton General Hospital, Southampton, UK.
authors.forename: Sophie
authors.initials: S
authors.lastname: Coles
authors.affiliation: Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK; University Department of Surgery, University of Southampton, Southampton General Hospital, Southampton, UK.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Albayati
authors.affiliation: Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK; University Department of Surgery, University of Southampton, Southampton General Hospital, Southampton, UK.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Nordon
authors.affiliation: Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK; University Department of Surgery, University of Southampton, Southampton General Hospital, Southampton, UK. Electronic address: cps@soton.ac.uk.
authors.forename: Cliff
authors.initials: C
authors.lastname: Shearman
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D002317:Cardiovascular Agents / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000401:mortality / Q000523:psychology; D004739:England; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D010465:Perception; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D010865:Pilot Projects; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017211:Treatment Failure; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality / Q000523:psychology
chemical_list: D002317:Cardiovascular Agents