PMID- 33775749 OWN - NLM STAT- MEDLINE DCOM- 20210927 LR - 20221207 IS - 1097-6809 (Electronic) IS - 0741-5214 (Linking) VI - 74 IP - 3 DP - 2021 Sep TI - Revascularization of intermittent claudicants leads to more chronic limb-threatening ischemia and higher amputation rates. PG - 771-779 LID - S0741-5214(21)00465-1 [pii] LID - 10.1016/j.jvs.2021.02.045 [doi] AB - BACKGROUND: 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 nonprocedural 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 health care 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 patients with IC with and without revascularization. METHODS: This institutional review board-approved, single institute retrospective study reviewed all patients with an initial diagnosis of IC between June 11, 2003, and April 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: We identified 1051 patients who met the inclusion criteria. Of these patients, 328 had at least one revascularization procedure and 723 did not. The revascularized group was younger than the nonrevascularized 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 diabetes mellitus type 2 (32.3% vs 16.3%; P < .001) and COPD (4.3% vs 1.7%; P = .017) in the revascularized group. Multivariable Cox regression found revascularization of patients with IC to be significantly associated with the progression to CLTI (hazard ratio, 2.9; 95% confidence interval, 2.0-4.2) and amputation (hazard ratio, 4.5; 95% confidence interval, 2.2-9.5). These findings were also demonstrated in propensity-matched cohorts of 218 revascularized and 340 nonrevascularized patients. CONCLUSIONS: 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, patients with IC benefit from revascularization procedures. CI - Published by Elsevier Inc. FAU - Madabhushi, Vashisht AU - Madabhushi V AD - Department of Surgery, University of Kentucky College of Medicine, Lexington, KY. FAU - Davenport, Daniel AU - Davenport D AD - Department of Surgery, University of Kentucky College of Medicine, Lexington, KY. FAU - Jones, Stuart AU - Jones S AD - Department of Surgery, University of Kentucky College of Medicine, Lexington, KY. FAU - Khoudoud, Sami Abul AU - Khoudoud SA AD - Department of Surgery, University of Kentucky College of Medicine, Lexington, KY. FAU - Orr, Nathan AU - Orr N AD - Department of Surgery, University of Kentucky College of Medicine, Lexington, KY. FAU - Minion, David AU - Minion D AD - Department of Surgery, University of Kentucky College of Medicine, Lexington, KY. FAU - Endean, Eric AU - Endean E AD - Department of Surgery, University of Kentucky College of Medicine, Lexington, KY. FAU - Tyagi, Sam AU - Tyagi S AD - Department of Surgery, University of Kentucky College of Medicine, Lexington, KY. Electronic address: sam.tyagi@uky.edu. LA - eng PT - Comparative Study PT - Journal Article DEP - 20210326 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 SB - IM MH - Aged MH - *Amputation, Surgical/adverse effects MH - Chronic Disease MH - Disease Progression MH - Endovascular Procedures/*adverse effects MH - Female MH - Humans MH - Intermittent Claudication/diagnosis/etiology/*therapy MH - Ischemia/diagnosis/etiology/*surgery MH - Male MH - Middle Aged MH - Peripheral Arterial Disease/complications/diagnosis/*therapy MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Time Factors MH - Treatment Outcome MH - Vascular Surgical Procedures/*adverse effects OTO - NOTNLM OT - Amputation OT - CLTI OT - Intermittent Claudication OT - Revascularization EDAT- 2021/03/30 06:00 MHDA- 2021/09/28 06:00 CRDT- 2021/03/29 05:54 PHST- 2020/05/18 00:00 [received] PHST- 2021/02/25 00:00 [accepted] PHST- 2021/03/30 06:00 [pubmed] PHST- 2021/09/28 06:00 [medline] PHST- 2021/03/29 05:54 [entrez] AID - S0741-5214(21)00465-1 [pii] AID - 10.1016/j.jvs.2021.02.045 [doi] PST - ppublish SO - J Vasc Surg. 2021 Sep;74(3):771-779. doi: 10.1016/j.jvs.2021.02.045. Epub 2021 Mar 26.