Clinical Outcomes And Management Of Patients Presenting With Intermittent Claudication And A Low Toe Brachial Index

Abstract

INTRODUCTION AND OBJECTIVES This study was performed to determine the natural history and outcomes after intervention of patients that presented with symptoms of claudication and a low toe brachial index (< 0.6). METHODS This was a retrospective single center study at a VA hospital. Patient charts were reviewed for claudication and TBI<0.6 from 4/2015 to 12/2015 and followed over 5 years. Patient demographics and clinical outcomes were collected. RESULTS Forty patients were followed with a total of 78 limbs (limbs presenting with rest pain or wounds were excluded) for a mean of 54.9 months. Demographic results for patients were 26 (65%) DM, 40 (100%) HTN, 40 (100%) HLD, 7 (17.5%) ESRD, 12 (30%) remote-smoker, and 14 (35%) current-smoker. Over the 5-years, 48 (61.5%) limbs remained stable without intervention or amputations. The number of limbs that received intervention without an ulcer or gangrene was 14 (17.9%), and the average time to vascular intervention was 6.7 months. The number of limbs that developed an ulcer or gangrene was 16 (20.5 %), and the average time to ulcer or gangrene was 13.7 months. The number of limbs that had an early major amputation was 11 (14.1%). Of the 19 limbs that underwent initial vascular intervention, 68.4% had an endovascular procedure and 31.6% had an open surgical revascularization. Of the limbs that had an initial endovascular, 3 (23.1%) had multiple endovascular interventions and 3 (23.1%) progressed to open surgical intervention. The survival rate of patients over 5 years with stable limbs was 63.2% and with unstable limbs was 47.6% CONCLUSIONS Patients presenting with intermittent claudication and TBI<0.6 are a high-risk subgroup to develop an ulcer or gangrene within 14 months. Therefore, these patients should have aggressive optimal medical management with close follow-up and a low threshold for early vascular intervention to prevent limb loss. This study was performed to determine the natural history and outcomes after intervention of patients that presented with symptoms of claudication and a low toe brachial index (< 0.6). This was a retrospective single center study at a VA hospital. Patient charts were reviewed for claudication and TBI<0.6 from 4/2015 to 12/2015 and followed over 5 years. Patient demographics and clinical outcomes were collected. Forty patients were followed with a total of 78 limbs (limbs presenting with rest pain or wounds were excluded) for a mean of 54.9 months. Demographic results for patients were 26 (65%) DM, 40 (100%) HTN, 40 (100%) HLD, 7 (17.5%) ESRD, 12 (30%) remote-smoker, and 14 (35%) current-smoker. Over the 5-years, 48 (61.5%) limbs remained stable without intervention or amputations. The number of limbs that received intervention without an ulcer or gangrene was 14 (17.9%), and the average time to vascular intervention was 6.7 months. The number of limbs that developed an ulcer or gangrene was 16 (20.5 %), and the average time to ulcer or gangrene was 13.7 months. The number of limbs that had an early major amputation was 11 (14.1%). Of the 19 limbs that underwent initial vascular intervention, 68.4% had an endovascular procedure and 31.6% had an open surgical revascularization. Of the limbs that had an initial endovascular, 3 (23.1%) had multiple endovascular interventions and 3 (23.1%) progressed to open surgical intervention. The survival rate of patients over 5 years with stable limbs was 63.2% and with unstable limbs was 47.6% Patients presenting with intermittent claudication and TBI<0.6 are a high-risk subgroup to develop an ulcer or gangrene within 14 months. Therefore, these patients should have aggressive optimal medical management with close follow-up and a low threshold for early vascular intervention to prevent limb loss.