What is the prognosis of peripheral arterial occlusive disease (PAOD)?

Updated: Mar 08, 2021
  • Author: Josefina A Dominguez, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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Answer

Whether a patient progresses to limb amputation largely depends on the number and severity of cardiovascular risk factors (ie, smoking, hypertension, or diabetes). Continued smoking has been identified as the adverse risk factor most consistently associated with the progression of PAOD. Other factors are the severity of disease at the time of the initial patient encounter and, in some studies, the presence of diabetes.

In an effort to identify patients at highest risk for progression to critical limb ischemia (CLI), a simple risk score for PAOD was developed: the Graz CLI score. [2] Age and diabetes were among the most aggressive risk factors (respective odds ratios, 2.0 and 3.1).

As with most patients with vascular disease, survival is less than that of age-matched control groups. Coronary artery disease, with a subsequent myocardial event, is the major contributor to outcome. Predicted all-cause mortality for PAOD patients with claudication is approximately 30% at 5 years of follow-up, 50% at 10 years, and 70% at 15 years. [3]

In a double-blind trial (N = 6564), Bonaca et al randomly assigned patients with PAOD who had undergone revascularization to receive either rivaroxaban 2.5 mg bid plus aspirin (n = 3286) or placebo plus aspirin (n = 3278). [4] ​ Compared with the patients in the aspirin-only group, those in the rivaroxaban-aspirin group had a significantly lower incidence of the composite outcome of acute limb ischemia, major amputation for vascular causes, myocardial infarction, ischemic stroke, or death from cardiovascular causes; however, they also had a significantly higher rate of major bleeding as defined by the International Society on Thrombosis and Haemostasis (ISTH).


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