Prognosis in Arteriosclerotic Peripheral Vascular Disease

Observations of the course of peripheral vascular disease were made in 1,198 patients who satisfied certain criteria as to signs and symptoms. The patients with coexistent diabetes were found to have a 10-year mortality rate of about 38 % compared to 11 % for nondiabetic patients. Diabetic patients also had a much higher rate of amputations (34%) than did nondiabetics (8%). Severe hypertension was also associated with some shortening of life expectancy, but its relation to frequency of amputation was complex. The amputation rate was lower in patients who had stopped smoking than in patients who continued to smoke or had never smoked. When acute occlusion of the femoral artery occurred, the prognosis was again much better in the nondiabetic than in the diabetic patients. In a group of 39 patients who underwent sympathectomy no favorable effect on the amputation rate was seen. Peripheral vascular disease in the presence of diabetes calls for rather aggressive measures. In the absence of diabetes, symptoms like intermittent claudication often persist for many years without worsening or even with some alleviation; the condition seems relatively benign, and conservative (nonsurgical) treatment is fairly satisfactory.