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November 1974

Intermittent Claudication: Surgical Significance

Author Affiliations

From the Framingham Heart Disease Epidemiology Study, Framingham, Mass (Dr. Kannel and Ms. McNamara), and the Boston University Medical Center, Boston (Dr. Peabody).

Arch Surg. 1974;109(5):693-697. doi:10.1001/archsurg.1974.01360050087019

A study was made of 162 persons with intermittent claudication who were observed for an average of 8.3 years. These were all the cases that evolved from a population cohort during 18 years of follow-up. They were essentially untreated until rest pain and tissue loss began. Only four progressed to major amputations and three to toe loss. A profile of the person developing intermittent claudication and gangrene in particular reveals a higher prevalence of diabetes and the cigarette habit, as well as hypertension and hypercholesteremia.

The comorbidity and subsequent incidence of coronary disease, stroke, and congestive failure was high. Within eight years, almost half developed a major cardiovascular event and 20% of the men and 30% of the women were dead.

This cardiovascular morbidity and mortality, as well as intermittent claudication, is predictable in the general population free of cardiovascular disease. Patients being considered for bypass surgery whose only complaint is claudication should be carefully evaluated for risk of cardiovascular morbidity.