J Golledge1,2,3,4, J V Moxon1,2, S Rowbotham1,5,6, J Pinchbeck1, L Yip1, R Velu3,4, F Quigley4, J Jenkins6, D R Morris1,7. 1. Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia. 2. Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia. 3. Department of Vascular and Endovascular Surgery, Townsville Hospital, Townsville, Queensland, Australia. 4. Department of Vascular and Endovascular Surgery, Mater Hospital, Townsville, Queensland, Australia. 5. School of Medicine, University of Queensland, Brisbane, Queensland, Australia. 6. Department of Vascular and Endovascular Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia. 7. Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Abstract
BACKGROUND: Revascularization is being used increasingly for the treatment of intermittent claudication and yet few studies have reported the long-term outcomes of this strategy. The aim of this study was to compare the long-term outcome of patients with intermittent claudication who underwent revascularization compared with a group initially treated without revascularization. METHODS: Patients with symptoms of intermittent claudication and a diagnosis of peripheral arterial disease were recruited from outpatient clinics at three hospitals in Queensland, Australia. Based on variation in the practices of different vascular specialists, patients were either treated by early revascularization or received initial conservative treatment. Patients were followed in outpatient clinics using linked hospital admission record data. The primary outcome was the requirement for major amputation. Kaplan-Meier curves, Cox regression and competing risks analyses were used to compare major amputation rates. RESULTS: Some 456 patients were recruited; 178 (39·0 per cent) underwent early revascularization and 278 (61·0 per cent) had initial conservative treatment. Patients were followed for a mean(s.d.) of 5·00(3·37) years. The estimated 5-year major amputation rate was 6·2 and 0·7 per cent in patients undergoing early revascularization and initial conservative treatment respectively (P = 0·003). Early revascularization was associated with an increased requirement for major amputation in models adjusted for other risk factors (relative risk 5·40 to 4·22 in different models). CONCLUSION: Patients presenting with intermittent claudication who underwent early revascularization appeared to be at higher risk of amputation than those who had initial conservative treatment.
BACKGROUND: Revascularization is being used increasingly for the treatment of intermittent claudication and yet few studies have reported the long-term outcomes of this strategy. The aim of this study was to compare the long-term outcome of patients with intermittent claudication who underwent revascularization compared with a group initially treated without revascularization. METHODS:Patients with symptoms of intermittent claudication and a diagnosis of peripheral arterial disease were recruited from outpatient clinics at three hospitals in Queensland, Australia. Based on variation in the practices of different vascular specialists, patients were either treated by early revascularization or received initial conservative treatment. Patients were followed in outpatient clinics using linked hospital admission record data. The primary outcome was the requirement for major amputation. Kaplan-Meier curves, Cox regression and competing risks analyses were used to compare major amputation rates. RESULTS: Some 456 patients were recruited; 178 (39·0 per cent) underwent early revascularization and 278 (61·0 per cent) had initial conservative treatment. Patients were followed for a mean(s.d.) of 5·00(3·37) years. The estimated 5-year major amputation rate was 6·2 and 0·7 per cent in patients undergoing early revascularization and initial conservative treatment respectively (P = 0·003). Early revascularization was associated with an increased requirement for major amputation in models adjusted for other risk factors (relative risk 5·40 to 4·22 in different models). CONCLUSION:Patients presenting with intermittent claudication who underwent early revascularization appeared to be at higher risk of amputation than those who had initial conservative treatment.
Authors: Maria Teresa B Abola; Jonathan Golledge; Tetsuro Miyata; Seung-Woon Rha; Bryan P Yan; Timothy C Dy; Marie Simonette V Ganzon; Pankaj Kumar Handa; Salim Harris; Jiang Zhisheng; Ramakrishna Pinjala; Peter Ashley Robless; Hiroyoshi Yokoi; Elaine B Alajar; April Ann Bermudez-Delos Santos; Elmer Jasper B Llanes; Gay Marjorie Obrado-Nabablit; Noemi S Pestaño; Felix Eduardo Punzalan; Bernadette Tumanan-Mendoza Journal: J Atheroscler Thromb Date: 2020-07-04 Impact factor: 4.928
Authors: Caitlin W Hicks; Peiqi Wang; William E Bruhn; Christopher J Abularrage; Ying W Lum; Bruce A Perler; James H Black; Martin A Makary Journal: J Vasc Surg Date: 2020-01-02 Impact factor: 4.268
Authors: Jonathan Golledge; Joseph V Moxon; Sophie Rowbotham; Jenna Pinchbeck; Frank Quigley; Jason Jenkins Journal: PLoS One Date: 2020-11-12 Impact factor: 3.240
Authors: Kristen J Bubb; Jason A Harmer; Meghan Finemore; Sarah Joy Aitken; Zara S Ali; Laurent Billot; Clara Chow; Jonathan Golledge; Rebecca Mister; Michael P Gray; Stuart M Grieve; Naomi Hamburg; Anthony C Keech; Sanjay Patel; Vikram Puttaswamy; Gemma A Figtree Journal: BMJ Open Date: 2021-09-28 Impact factor: 2.692
Authors: Ahmed A Naiem; Robert James Doonan; Oren K Steinmetz; Kent S MacKenzie; Elie Girsowicz; Jason P Bayne; Daniel I Obrand; Heather L Gill Journal: Vascular Date: 2021-08-16 Impact factor: 1.105
Authors: Jonathan Golledge; Sophie Rowbotham; Ramesh Velu; Frank Quigley; Jason Jenkins; Michael Bourke; Bernie Bourke; Shivshankar Thanigaimani; Dick C Chan; Gerald F Watts Journal: J Am Heart Assoc Date: 2020-03-14 Impact factor: 5.501