OBJECTIVE: The purpose of this study was to delineate the natural history of claudication and determine risk factors for ischemic rest pain (IRP) and ischemic ulceration (IU) among patients with claudication. METHODS: We prospectively collected data on 1244 men with claudication during a 15-year period, including demographics, clinical risk factors, and ankle-brachial index (ABI). We followed these patients serially with ABIs, self-reported walking distance (WalkDist), and monitoring for IRP and IU. We used Kaplan-Meier and proportional hazards modeling to find independent predictors of IRP and IU. RESULTS: Mean follow-up was 45 months; statistically valid follow-up could be carried out for as long as 12 years. ABI declined an average of 0.014 per year. WalkDist declined at an average rate of 9.2 yards per year. The cumulative 10-year risks of development of IU and IRP were 23% and 30%, respectively. In multivariate analysis using several clinical risk factors, we found that only DM (relative risk [RR], 1.8) and ABI (RR, 2.2 for 0.1 decrease in ABI) predicted the development of IRP. Similarly, only DM (RR, 3.0) and ABI (RR, 1.9 for 0.1 decrease in ABI) were significant predictors of IU. CONCLUSION: This large serial study of claudication is, to our knowledge, the longest of its kind. We documented an average rate of ABI decline of 0.014 per year and a decline in WalkDist of 9.2 yards per year. Two clinical factors, ABI and DM, were found to be associated with the development of IRP and IU. Our findings may be useful in predicting the clinical course of claudication.
OBJECTIVE: The purpose of this study was to delineate the natural history of claudication and determine risk factors for ischemic rest pain (IRP) and ischemic ulceration (IU) among patients with claudication. METHODS: We prospectively collected data on 1244 men with claudication during a 15-year period, including demographics, clinical risk factors, and ankle-brachial index (ABI). We followed these patients serially with ABIs, self-reported walking distance (WalkDist), and monitoring for IRP and IU. We used Kaplan-Meier and proportional hazards modeling to find independent predictors of IRP and IU. RESULTS: Mean follow-up was 45 months; statistically valid follow-up could be carried out for as long as 12 years. ABI declined an average of 0.014 per year. WalkDist declined at an average rate of 9.2 yards per year. The cumulative 10-year risks of development of IU and IRP were 23% and 30%, respectively. In multivariate analysis using several clinical risk factors, we found that only DM (relative risk [RR], 1.8) and ABI (RR, 2.2 for 0.1 decrease in ABI) predicted the development of IRP. Similarly, only DM (RR, 3.0) and ABI (RR, 1.9 for 0.1 decrease in ABI) were significant predictors of IU. CONCLUSION: This large serial study of claudication is, to our knowledge, the longest of its kind. We documented an average rate of ABI decline of 0.014 per year and a decline in WalkDist of 9.2 yards per year. Two clinical factors, ABI and DM, were found to be associated with the development of IRP and IU. Our findings may be useful in predicting the clinical course of claudication.
Authors: Bianca Lw Bendermacher; Joep Aw Teijink; Edith M Willigendael; Marie-Louise Bartelink; Harry R Büller; Ron Jg Peters; Jelis Boiten; Machteld Langenberg; Martin H Prins Journal: Br J Gen Pract Date: 2006-12 Impact factor: 5.386
Authors: Joshua A Beckman; Meredith S Duncan; Scott M Damrauer; Quinn S Wells; Joey V Barnett; David H Wasserman; Roger J Bedimo; Adeel A Butt; Vincent C Marconi; Jason J Sico; Hilary A Tindle; Marc P Bonaca; Aaron W Aday; Matthew S Freiberg Journal: Circulation Date: 2019-07-08 Impact factor: 29.690
Authors: Mary M McDermott; Robert Sufit; Takashi Nishida; Jack M Guralnik; Luigi Ferrucci; Lu Tian; Kiang Liu; Jin Tan; William H Pearce; Joseph R Schneider; Leena Sharma; Michael H Criqui Journal: Arch Intern Med Date: 2006-10-09
Authors: Ayotunde O Dokun; Sehoon Keum; Surovi Hazarika; Yongjun Li; Gregory M Lamonte; Ferrin Wheeler; Douglas A Marchuk; Brian H Annex Journal: Circulation Date: 2008-02-19 Impact factor: 29.690
Authors: Terence E Ryan; Dean J Yamaguchi; Cameron A Schmidt; Tonya N Zeczycki; Saame Raza Shaikh; Patricia Brophy; Thomas D Green; Michael D Tarpey; Reema Karnekar; Emma J Goldberg; Genevieve C Sparagna; Maria J Torres; Brian H Annex; P Darrell Neufer; Espen E Spangenburg; Joseph M McClung Journal: JCI Insight Date: 2018-11-02