Prognosis

Peripheral arterial disease (PAD) is related to morbidity and mortality from other types of atherosclerotic disease, even after adjustment for known common risk factors.[21] This explains the importance of general cardiovascular prevention in patients with PAD.[2] 

Ankle-brachial index (ABI) is a marker for cardiovascular events beyond the diagnosis of PAD.[1] A more rapid deterioration in ABI carries a worse prognosis for all-cause mortality and cardiovascular disease mortality, independent of baseline ABI and potential confounding variables.[21]​ Presence of hypertension has been associated with a longitudinal decline in ABI.[2]

Claudication

For the most part, claudication symptoms remain stable and do not worsen rapidly. Two clinical risk factors, significantly reduced ABI and diabetes, increase the risk for chronic limb ischaemia.[2]

Critical limb ischaemia

At 1 year, 25% of patients with critical limb ischaemia will have died and 30% will have undergone amputation. At 5 years, more than 60% of patients with critical limb ischaemia will have died.[110]

Acute limb ischaemia

The long-term prognosis for the limb is dependent on speed and completeness of revascularisation prior to onset of permanent tissue and nerve damage.

Impact of common comorbidities

The presence of specific comorbidities and risk factors increases the risk for major adverse cardiovascular events and major adverse limb events in those with PAD. Multisociety US guidelines recommend that patients with PAD should be assessed for these risk amplifiers when developing patient-focused treatment recommendations.[2]

  • Hypertension

  • Dyslipidaemia

  • Diabetes

  • Chronic kidney disease/end-stage renal disease

  • Depression

  • Atherosclerotic disease in more than one vascular bed (PAD, coronary artery disease, cerebrovascular disease)

  • Microvascular disease (retinopathy, neuropathy, nephropathy)

  • Current smoking/tobacco use

  • Older age and geriatric syndromes (frailty, mobility impairment, sarcopenia, malnutrition)

Patients with PAD and comorbid heart failure have an increased risk of major adverse cardiovascular events and all-cause mortality.[1]

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