Peripheral Artery Disease Progression maybe more common than previously thought

This paper is a meta-analysis looking at progression of peripheral arterial disease (PAD).  Historically, PAD has been considered to have a relatively benign course with only a small percentage of patient progression to the worst for of PAD, critical limb ischemia (CLI). 

In general, patients with PAD fall into 3 categories:

1. Asymptomatic - patients have     no symptoms
2. Intermittent Claudication     (IC) - patients get leg pain when exercising
3. CLI - patients have severe     load of blood flow with wounds and pain at rest

Historically, it has been felt that most asymptomatic patients will never develop symptoms.  In this review approximately 7% of asymptomatic patients developed symptoms of IC.

More concerning, is the common assumptions that most patients with IC WILL NOT progress to CLI.  In fact, most guidelines will state the risk of a patient with IC have only a 1-2% risk of developing CLI.  In the study, the authors found that number to be considerably higher and consider that patients have a > 20% risk of developing CLI.  And worse, up to a quarter of those patients went on to amputation.

This paper adds to growing consensus that PAD is a severe disease with significant implications for patient health, well-being and quality of life.

‍