In a multi-institutional cohort of patients with intermittent claudication (IC), care deemed inappropriate, or where the risk outweighs the benefit, by the SVS appropriate use criteria (AUC) for the management of IC was “common” and associated with increased risk of symptom recurrence, reintervention and amputation, a retrospective review showed.
Furthermore, in patients with mild-to-moderate lifestyle limitation, appropriate treatment was associated with no amputation, whereas inappropriate treatment was associated with a greater than 8% incidence of major amputation.
The data were presented at the 2025 Western Vascular Society (WVS) annual meeting (Sept. 14– 17) in Ojai, California by Christine Mavilian, MS, a medical student at the University of California, Los Angeles (UCLA), attracting first place in the Robert Hye Memorial Best Resident/Trainee Competition. The review included 372 patients treated for claudication between 2005 and 2024 at seven institutions. Some 65% (245) were placed in the appropriate and indeterminate category, and 35% (127) the inappropriate. At two years from initial presentation, 57% were free from invasive intervention in the appropriate/indeterminate group compared to 19% in the inappropriate group, the UCLA researchers found. “Following revascularization, patients in the inappropriate group experienced significantly higher rates of symptom recurrence and significantly higher rates of reintervention,” Mavilian told WVS 2025.
“At two years post-revascularization, freedom from symptom recurrence was 60% in the appropriate/indeterminate group compared to 49% in the inappropriate group. This approached statistical significance. At five years post-revascularization, 72% in the appropriate/indeterminate group were free from reintervention compared to 44% in the inappropriate group.
“A total of 157 patients presented with mild-to-moderate lifestyle limitation, and, in this group, no patients categorized appropriate/indeterminate had an amputation, compared to patients categorized as inappropriate, who had a major amputation rate of 8.4% and prior amputation rate of 7.6%.”
