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The progression rate of peripheral arterial disease in patients with intermittent claudication: a systematic review

The progression rate of peripheral arterial disease in patients with intermittent claudication: a systematic review
The progression rate of peripheral arterial disease in patients with intermittent claudication: a systematic review
Background: intermittent claudication (IC) is the most common symptom of peripheral arterial disease and is generally treated conservatively due to limited prognostic evidence to support early revascularisation in the individual patient. This approach may lead to the possible loss of opportunity of early revascularisation in patients who are more likely to deteriorate to critical limb ischaemia. The aim of this review is to evaluate the available literature related to the progression rate of symptomatic peripheral arterial disease.

Methods: we conducted a systematic review of the literature in PubMed and MEDLINE, Cochrane library, Elsevier, Web of Science, CINAHL and Opengrey using relevant search terms to identify the progression rate of peripheral arterial disease in patients with claudication. Outcomes of interest were progression rate in terms of haemodynamic measurement and time to development of adverse outcomes. Two independent reviewers determined study eligibility and extracted descriptive, methodologic, and outcome data. Quality of evidence was evaluated using the Cochrane recommendations for assessing risk of bias and was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: seven prospective cohort studies and one retrospective cohort study were identified and included in this review with the number of participants in each study ranging from 38 to 1244. Progression rate reports varied from a yearly decrease of 0.01 in ankle-brachial pressure index (ABPI) to a yearly decrease ABPI of 0.014 in 21% of participants. Quality of evidence ranged from low to moderate mostly due to limited allocation concealment at recruitment and survival selection bias.

Conclusions: progression of PAD in IC patients is probably underestimated in the literature due to study design issues. Predicting which patients with claudication are likely to deteriorate to critical limb ischaemia is difficult since there is a lack of evidence related to lower limb prognosis. Further research is required to enable early identification of patients at high risk of progressing to critical ischaemia and appropriate early revascularisation to reduce lower limb morbidity.
1757-1146
1-9
Mizzi, Anabelle
bfdf628a-5c66-45a1-bed9-4c3a70717683
Cassar, Kevin
72f34936-86f3-404f-882a-4df66db42ba1
Bowen, Catherine
fd85c3c5-96d9-49b8-86c6-caa94e1a222b
Formosa, Cynthia
07fc4730-7508-44a5-a76b-69e55134a641
Mizzi, Anabelle
bfdf628a-5c66-45a1-bed9-4c3a70717683
Cassar, Kevin
72f34936-86f3-404f-882a-4df66db42ba1
Bowen, Catherine
fd85c3c5-96d9-49b8-86c6-caa94e1a222b
Formosa, Cynthia
07fc4730-7508-44a5-a76b-69e55134a641

Mizzi, Anabelle, Cassar, Kevin, Bowen, Catherine and Formosa, Cynthia (2019) The progression rate of peripheral arterial disease in patients with intermittent claudication: a systematic review. Journal of Foot and Ankle Research, 12, 1-9, [40]. (doi:10.1186/s13047-019-0351-0).

Record type: Article

Abstract

Background: intermittent claudication (IC) is the most common symptom of peripheral arterial disease and is generally treated conservatively due to limited prognostic evidence to support early revascularisation in the individual patient. This approach may lead to the possible loss of opportunity of early revascularisation in patients who are more likely to deteriorate to critical limb ischaemia. The aim of this review is to evaluate the available literature related to the progression rate of symptomatic peripheral arterial disease.

Methods: we conducted a systematic review of the literature in PubMed and MEDLINE, Cochrane library, Elsevier, Web of Science, CINAHL and Opengrey using relevant search terms to identify the progression rate of peripheral arterial disease in patients with claudication. Outcomes of interest were progression rate in terms of haemodynamic measurement and time to development of adverse outcomes. Two independent reviewers determined study eligibility and extracted descriptive, methodologic, and outcome data. Quality of evidence was evaluated using the Cochrane recommendations for assessing risk of bias and was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: seven prospective cohort studies and one retrospective cohort study were identified and included in this review with the number of participants in each study ranging from 38 to 1244. Progression rate reports varied from a yearly decrease of 0.01 in ankle-brachial pressure index (ABPI) to a yearly decrease ABPI of 0.014 in 21% of participants. Quality of evidence ranged from low to moderate mostly due to limited allocation concealment at recruitment and survival selection bias.

Conclusions: progression of PAD in IC patients is probably underestimated in the literature due to study design issues. Predicting which patients with claudication are likely to deteriorate to critical limb ischaemia is difficult since there is a lack of evidence related to lower limb prognosis. Further research is required to enable early identification of patients at high risk of progressing to critical ischaemia and appropriate early revascularisation to reduce lower limb morbidity.

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Accepted/In Press date: 29 July 2019
Published date: 6 August 2019

Identifiers

Local EPrints ID: 432926
URI: http://eprints.soton.ac.uk/id/eprint/432926
ISSN: 1757-1146
PURE UUID: 7fb49dcc-aea6-44b7-a723-2eb7d35d6454
ORCID for Catherine Bowen: ORCID iD orcid.org/0000-0002-7252-9515

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Date deposited: 01 Aug 2019 16:30
Last modified: 26 Nov 2021 02:45

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Contributors

Author: Anabelle Mizzi
Author: Kevin Cassar
Author: Catherine Bowen ORCID iD
Author: Cynthia Formosa

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