Department of Medicine, Cardiovascular Division, Section of Vascular Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
Vasc Med. 2012 Feb;17(1):10-6. doi: 10.1177/1358863X11431106.
The pathophysiology and time course of an individual converting from asymptomatic peripheral artery disease (PAD) to symptomatic claudication is unclear. The objectives of this study were: (1) to characterize the extent of atherosclerotic disease in individuals with an abnormal ankle-brachial index (ABI), but without claudication; and over 1 year of follow-up to (2) evaluate the progression of PAD using ultrasound imaging, (3) determine changes in the ABI and leg pain symptoms, and (4) correlate PAD progression with changes in the ABI and leg symptoms. We hypothesized that PAD progression would be associated with the development of claudication and changes in the ABI, 6-minute walk distance (6-MWD), and walking quality of life. Individuals with a reduced ABI but without typical intermittent claudication noted on community screening were invited to undergo baseline and 1-year follow-up assessment, including duplex ultrasound. The initial and repeat evaluations included measurement of the ABI, lower extremity duplex arterial mapping, and assessment of leg pain and functional status. Of the 50 people studied, 44 (88%) had significant atherosclerotic lesions in the lower extremity arteries, affecting 80 legs. A total of 33 of 50 individuals (66%) returned for the 1-year follow-up visit. On ultrasound examination, two of 18 normal legs developed PAD, and in 48 legs with PAD at baseline, 17 legs (35%) developed new or progressive lesions. Thirteen legs developed new claudication. Overall, there was no significant worsening in the ABI, 6-MWD, or the Walking Impairment Questionnaire (WIQ). However, legs with new lesions or lesion progression were significantly more likely to develop claudication, and the 13 legs (seven subjects) developing claudication showed a significant decline in the 6-MWD. In conclusion, these data indicate that a significant number of people with asymptomatic PAD show progression over 1 year, that such individuals are more likely to develop claudication, and that those developing claudication have a significant decrease in their 6-MWD.
个体从无症状外周动脉疾病 (PAD) 转变为有症状跛行的病理生理学和时间进程尚不清楚。本研究的目的是：(1) 描述踝肱指数 (ABI) 异常但无跛行的个体中动脉粥样硬化疾病的程度；并在 1 年的随访中，(2) 使用超声成像评估 PAD 的进展，(3) 确定 ABI 和腿部疼痛症状的变化，以及 (4) 相关 PAD 进展与 ABI 和腿部症状的变化。我们假设 PAD 进展与跛行的发展以及 ABI、6 分钟步行距离 (6-MWD) 和步行生活质量的变化相关。在社区筛查中发现 ABI 降低但无典型间歇性跛行的个体被邀请接受基线和 1 年随访评估，包括双功能超声检查。初始和重复评估包括 ABI 测量、下肢双功能动脉绘图以及腿部疼痛和功能状态评估。在研究的 50 人中，44 人 (88%) 下肢动脉存在明显的动脉粥样硬化病变，影响 80 条腿。共有 50 人中有 33 人 (66%) 参加了 1 年的随访。在超声检查中，18 条正常腿中有 2 条出现 PAD，而在基线时患有 PAD 的 48 条腿中，17 条腿 (35%) 出现新的或进展性病变。13 条腿出现新的跛行。总的来说，ABI、6-MWD 或步行障碍问卷 (WIQ) 没有明显恶化。然而，出现新病变或病变进展的腿更有可能出现跛行，出现跛行的 13 条腿 (7 名患者) 的 6-MWD 显著下降。总之，这些数据表明，相当数量的无症状 PAD 患者在 1 年内会出现进展，这些患者更有可能出现跛行，而出现跛行的患者 6-MWD 会显著下降。
