The prognosis of non-critical limb ischaemia: a systematic review of population-based evidence

Background. Peripheral arterial occlusive disease (PAOD) is the most common peripheral vascular disorder in the elderly. A clear picture of the diseas e's course, especially in patients with non-critical limb ischaemia (Fontai ne stages I and II), is essential for the general practitioner, who plays a key role in the diagnosis and management of PAOD. Aim. To evaluate the population-based evidence on the course and prognosis of PAOD. Methods. An exhaustive literature search yielded 16 population-based studie s on the prognosis of PAOD. The methodological qualities of the studies wer e assessed according to eight criteria. Results. Thirteen studies of high methodological quality show that data on the course, cardiovascular morbidity, and mortality of asymptomatic PAOD ar e scarce. Only a small group of asymptomatic patients seem to develop inter mittent claudication symptoms. However, asymptomatic patients appear to hav e the same increased risk for cardiovascular morbidity and mortality when c ompared with claudicants. No data were available on prognostic factors for intermittent claudication and cardiovascular morbidity in asymptomatic pati ents. The course, cardiovascular morbidity, and mortality of symptomatic PA OD are better documented. A small group of claudicants experience symptom p rogression. Smoking, hypertension, increasing age, and diabetes are the mos t relevant risk factors for intermittent claudication. Claudicants are at a higher risk for developing other cardiovascular diseases, resulting in a s ignificantly increased mortality mainly owing to coronary heart disease. in termittent claudication and a low ankle-brachial pressure index are signifi cant predictors of mortality. Men had intermittent claudication and symptom progression more often than women. Cardiovascular (co-)morbidity was commo n in both male and female PAOD patients, but male PAOD patients had a highe r mortality compared with female PAOD patients. Conclusion. Given the current knowledge on the prognosis of PAOD in the gen eral population, an important task for (secondary) prevention is reserved f or the general practitioner. Further research is required to document the c ourse and prognosis of asymptomatic PAOD patients.