Question

A 58-year-old male chronic smoker diabetic and having normal coronaries presents with bilateral calf claudication. Femoral pulses are palpable but distal pulses are absent with bilateral ABI of 0.5 and no rest pain or tissue loss. He has following doubts after reading about peripheral vascular disease on internet and needs a counselling session with the treating vascular surgeon.
What are the chances of losing the limb over the next few years & what are the chances of mortality?

Hint:

In patients with PAD, managing risk factors like smoking, diabetes, and hypertension is crucial in reducing the risk of limb loss and mortality.

Answer 1

Step 1: Understanding the patient's condition.
The patient's bilateral calf claudication, combined with a low ABI, suggests moderate to severe peripheral arterial disease. The risk of limb loss in PAD patients depends on the severity of the disease, progression of atherosclerosis, and the development of critical limb ischemia (CLI), which is characterized by rest pain, ulcers, or tissue necrosis.

Step 2: Risk of limb loss.
The risk of losing the limb increases if the disease progresses to critical limb ischemia (CLI). In patients with ABI of 0.5, the risk of developing CLI is higher. However, with proper medical management (including smoking cessation, glycemic control, and appropriate use of antiplatelet agents), the risk of limb loss can be reduced. Surgical intervention like revascularization can further decrease the risk.

Step 3: Mortality risk.
The risk of mortality in patients with PAD is also elevated, particularly if they have multiple risk factors like smoking and diabetes. Studies show that the 5-year mortality rate in patients with PAD can range from 20-40%, especially if there is significant cardiovascular involvement. The risk of mortality is higher in patients who develop critical limb ischemia or are unable to manage the disease effectively.

Step 4: Conclusion.
If left untreated, the patient has a moderate to high risk of both limb loss and mortality, depending on disease progression. Early intervention and management can significantly improve prognosis.