The fate of the claudicant limb

Intermittent claudication deteriorates in no more than 25% of patients. Distance walked on a treadmill is not a precise indicator of outcome, because the same impairment may result in severe limitation for one patient, but may not affect quality of life as judged by another. Only 18% of claudicant patients require surgical revascularization over 10 years, and smoking and ankle-brachial index are the most important markers of this type of surgery. Progression of claudication in critical leg ischaemia varies from 3.8% to 25% (5-year follow-up) and to 41% (8-year follow-up), and the amputation rate is approximately 10% (10-year follow-up). Inflammation and endothelial dysfunction appear to be the major risk factors for progression, but their occurrence is unpredictable and differs from patient to patient; consequently, further studies are required to clarify these aspects.