Natural history

Knowledge of the natural history of arterial claudication enables the condition to be managed optimally.

Of those that present with intermittent claudication:

• one third undergo spontaneous remission of symptoms within two years, without any treatment
  
  
• one third remain symptomatically stable
  
  
• one third deteriorate, either becoming severely disabled by restriction of walking ability or developing symptoms of more severe ischaemia such as rest pain

Untreated, about 10% of all patients would progress to necrosis and amputation. Abstinence from smoking greatly improves outcome. The development of collaterals is attributed to the cessation of symptoms in those patients who improve.

The life expectancy of claudicants is approximately 10 years less than that of other individuals of the same age. Their 5-year, 10-year and 15-year mortality rates from the time of presentation are 30%, 50% and 70% respectively. Most die from other manifestations of atherosclerosis such as ischaemic heart disease or stroke.

Reference.

1. Lower limb peripheral arterial disease. NICE Clinical Guideline (August 2012, updated December 2020)