Relationship of severity of lower limb peripheral vascular disease to mortality and morbidity: a six-year follow-up study.

Among the considerations affecting the therapeutic approach to patients with atherosclerosis of the lower extremities is their associated risk of death, myocardial infarction, stroke, and limb loss. To investigate the relationship of these events to the severity of peripheral vascular disease we undertook a 6-year review of 247 consecutive patients undergoing lower extremity noninvasive vascular assessment. There were 130 men and 117 women with a mean age of 65 +/- 15 years. Patients were categorized into four groups according to their ankle-brachial pressure indexes at their first visit. Ninety-seven patients had normal indexes (greater than or equal to 0.92), 86 had indexes of 0.50 to 0.91, 39 had indexes of 0.31 to 0.49, and 25 had indexes within the ischemic range, less than or equal to 0.30. At 6 years 64% of the patients with ischemic indexes were dead. This incidence was significantly higher than that of any other patient category (p less than 0.01). Diabetes also had a significantly adverse effect on survival. The incidence of stroke and myocardial infarction was similar for all disease groups. Thirteen percent and 32% of patients with indexes of 0.31 to 0.49 and less than or equal to 0.30, respectively, underwent limb amputation. We conclude that patients with evidence of mild to moderate peripheral vascular disease have a survival rate and risk of vascular-related disorders similar to those of patients of similar age with little evidence of disease, whereas an ankle-brachial pressure index less than or equal to 0.30 is associated with a malignant prognosis.