eMedicine Specialties > Vascular Surgery > Medical Topics

Peripheral Arterial Occlusive Disease: Follow-up

Author: Vincent Lopez Rowe, MD, Assistant Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center
Contributor Information and Disclosures

Updated: Oct 26, 2009

Follow-up

Further Outpatient Care

  • Patients should be seen every 4-6 months to assess the effects of medical therapy. Review changes in walking distance, smoking habits, eating habits, and exercise performance.
  • Control hypertension and diabetes if necessary. A repeat pulse examination and ABI complete the follow-up evaluation.
  • Patients with worsening symptoms may require intervention and referral to a vascular surgeon.

Complications

  • The most feared consequence is severe limb-threatening ischemia leading to amputation. However, studies of large patient groups with claudication reveal that amputation is uncommon.
    • Boyd prospectively followed 1440 patients with intermittent claudication for as long as 10 years and reported that only 12.2% required amputation.
    • In the Framingham study, only 1.6% of patients with claudication reached the amputation stage after 8.3 years of follow-up.

Prognosis

  • Whether a patient progresses to limb amputation largely depends on the number and severity of cardiovascular risk factors (ie, smoking, hypertension, diabetes).
  • Continued smoking has been identified as the most consistent adverse risk factor associated with the progression of the disease.
  • Other factors are the severity of disease at the time of the initial patient encounter and, in some studies, the presence of diabetes.
  • As with most patients with vascular disease, survival is less than that of age-matched control groups. Coronary artery disease, with a subsequent myocardial event, is the major contributor to outcome.
  • Predicted mortality rates for patients with claudication at 5, 10, and 15 years of follow-up are approximately 30%, 50%, and 70%, respectively.

Patient Education

For excellent patient education resources, visit eMedicine's Circulatory Problems Center and Cholesterol Center. Also, see eMedicine's patient education articles Peripheral Vascular Disease, High Cholesterol, and Cholesterol FAQs.

Miscellaneous

Medicolegal Pitfalls

Misdiagnosis for intermittent claudication rarely leads directly to limb loss. However, make early referrals to a vascular surgeon to decrease the likelihood of any legal action.

 


More on Peripheral Arterial Occlusive Disease

Overview: Peripheral Arterial Occlusive Disease
Differential Diagnoses & Workup: Peripheral Arterial Occlusive Disease
Treatment & Medication: Peripheral Arterial Occlusive Disease
Follow-up: Peripheral Arterial Occlusive Disease
Multimedia: Peripheral Arterial Occlusive Disease
References
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References

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Further Reading

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Keywords

peripheral arterial occlusive disease, PAOD, chronic arterial insufficiency, lower extremity claudication, lower extremity ischemia, lower-extremity claudication, lower-extremity ischemia, peripheral vascular disease, cholesterol, smoking, hypertension

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Contributor Information and Disclosures

Author

Vincent Lopez Rowe, MD, Assistant Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center
Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, Association for Academic Surgery, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, and Society for Vascular Surgery
Disclosure: Nothing to disclose.

Medical Editor

William H Pearce, MD, Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University School of Medicine
William H Pearce, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Association of VA Surgeons, Central Surgical Association, New York Academy of Sciences, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, and Western Surgical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Travis J Phifer, MD, Chief, Division of Vascular Surgery, Professor, Department of Surgery and Radiology, Louisiana State University Health Sciences Center in Shreveport
Travis J Phifer, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Society for Academic Emergency Medicine, Society for Vascular Surgery, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

William H Pearce, MD, Chief, Division of Vascular Surgery, Violet and Charles Baldwin Professor of Vascular Surgery, Department of Surgery, Northwestern University School of Medicine
William H Pearce, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Association for Academic Surgery, Association of VA Surgeons, Central Surgical Association, New York Academy of Sciences, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, and Western Surgical Association
Disclosure: Nothing to disclose.

 
 
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