The fate of patients with intermittent claudication in the 21st century revisited – results from the CAVASIC Study

Abstract

Patients with intermittent claudication carry a high risk for cardiovascular complications. The TransAtlantic Inter-Society Consensus (TASC) Group estimated a five-year overall mortality of 30% for these patients, the majority dying from cardiovascular causes. We investigated whether this evaluation is still applicable in nowadays patients. We therefore prospectively followed 255 male patients with intermittent claudication from the CAVASIC Study during 7 years for overall mortality, vascular morbidity and mortality and local PAD outcomes. Overall mortality reached 16.1% (n = 41). Most patients died from cancer (n = 20). Half of patients (n = 22; 8.6%) died within the first five years. Incident cardiovascular events were observed among 70 patients (27.5%), 54 (21.2%) during the first five years. Vascular mortality was low with 5.1% (n = 13) for the entire and 3.1% for the first five years of follow-up. Prevalent coronary artery disease did not increase the risk to die from all or vascular causes. PAD symptoms remained stable or improved in the majority of patients (67%). In summary, compared to TASC, the proportion of cardiovascular events did not markedly decrease over the last two decades. Vascular mortality, however, was low among our population. This indicates that nowadays patients more often survive cardiovascular events and a major number dies from cancer.

Mortality After Paclitaxel-Coated Device Use in Dialysis Access: A Systematic Review and Meta-Analysis

“…41,42 In comparison, contemporary natural history studies of claudication demonstrate a more favorable outlook, with 5-year survival rates that range between 73% and 91%. [43][44][45][46] Consideration of those relative survival rates helps to contextualize the results from the meta-analysis by Katsanos et al, 7 which found the most pronounced mortality risk at the longer follow-up of 5 years, when most patients with ESRD would have succumbed to the disease or its complications. It is important that we interpret the paclitaxel safety signal alongside a complete understanding of the evidence for patient benefit that may be gained through the use of paclitaxel-coated balloon angioplasty in DA.…”

Paclitaxel-Coated Zilver PTX Drug-Eluting Stent Treatment Does Not Result in Increased Long-Term All-Cause Mortality Compared to Uncoated Devices

“…McDermott et al [30] reported a 3-year cancer mortality rate of 3.0% in a cohort of 1314 PAD patients, corresponding to a 1-year annualized rate of 1.0% (i.e., approximately 5% through 5 years). Rantner et al [31] reported that cancer was the leading cause of death in a population of 255 intermittent claudication patients, occurring in 3.9% of patients (10/255) within 5 years. These published rates for cancer-related mortality in PAD patients are comparable to the rates seen in the Zilver PTX RCT (4.8%) and Japan PMS (3.0%) studies through 5 years.…”

Major adverse limb events and major adverse cardiac events after contemporary lower extremity bypass and infrainguinal endovascular intervention in patients with claudication

“…Patients with PAD have disease that affects multiple vascular beds, not only those vessels located in the lower extremities; they are therefore known to be at a high risk of MACE, even prior to undergoing an open or endovascular intervention. 22-24 The general anesthesia required for most LEB procedures coupled with potential blood loss drives the increased theoretical risk compared to IEI. For this reason, preference for IEI over LEB increases as surgical risk increases, as demonstrated in the baseline demographics of this study.…”