La revascularisation des patients claudiquants majore le risque d'ischémie critique chronique et le taux d'amputation.

Introduction: There is an increasing incidence of peripheral arterial disease (PAD). The most common symptomatic presentation of PAD is intermittent claudication (IC), reproducible leg pain with ambulation. The progression of symptoms beyond IC is rare, and a non-procedural approach of smoking cessation, supervised exercise therapy and best medical therapy can mitigate progression of IC. Despite the lack of limb or life-threatening sequelae of IC, invasive treatment strategies of IC have experienced rapid growth. Within our healthcare system, PAD is treated by multiple disciplines with varying practice patterns, providing an opportunity to investigate the progression of IC based on treatment strategy. This study aims to compare PAD progression and amputation in IC patients with and without revascularization.

Methods: This IRB-approved, single institute retrospective study reviewed all patients with an initial diagnosis of IC between 6/11/2003 to 4/24/2019. Revascularization was defined as endovascular or open. Time to chronic limb threatening ischemia (CLTI) diagnosis and amputation were stratified by revascularization status using the Kaplan-Meier method. The association between revascularization status and each of CLTI progression and amputation using multivariable Cox regression, adjusting for demographic and clinical potential confounding variables was assessed.

Results: 1051 patients who met inclusion criteria were identified. Of these patients, 328 had at least one revascularization procedure and 723 did not. The revascularized group was younger than the non-revascularized group (60.3 years vs. 62.1 years, P = .013). There was no significant difference in sex or comorbidities in the two groups other than a higher rate of DMII (32.3% vs 16.3%, P < 0.001) and COPD (4.3% vs. 1.7%, P = .017) in the revascularized group. Multivariable Cox regression found revascularization of IC patients to be significantly associated with the progression to CLTI (HR 2.9, 95% CI 2.0, 4.2) and amputation (HR 4.5 95% CI 2.2, 9.5). These findings were also demonstrated in propensity-matched cohorts of 218 revascularized and 340 non-revascularized patients.

Conclusion: Revascularization of patients with IC is associated with an increased rate of progression to CLTI and increased amputation rates. Given these findings, further studies are required to identify which, if any, IC patients benefit from revascularization procedures.