Contralateral symptoms after unilateral intervention for peripheral occlusive disease

Abstract

Objective: The objectives of this study were (1) to determine the incidence of contralateral symptoms in patients with a unilateral intervention for peripheral arterial occlusive disease and (2) to identify characteristics that predict these symptoms.

Subjects and setting: We included patients who had a unilateral surgical or percutaneous intervention for peripheral arterial occlusive disease at the Brigham and Women's Hospital (Boston) between 1990 and 1995 (n = 532).

Main outcome measure: The main outcome measure was the first occurrence of contralateral critical ischemia or intermittent claudication.

Results: The annual incidence rate of contralateral critical ischemia was considerable, ranging from 3.3% to 8.3% during the first 4 years after the initial ipsilateral intervention. The annual incidence rate of contralateral critical ischemia and claudication combined varied from 7.7% to 21.3%. Cox regression analysis indicated that the initial ipsilateral symptoms and the initial contralateral ankle/brachial index can be used to predict the occurrence of contralateral symptoms. After correction was done for these two variables, we found no statistically significant effects for other factors including age, sex, diabetes, smoking, antihypertensive medication, history of coronary artery disease, the type of intervention, and the arterial level of the intervention.

Conclusions: The results of our analysis emphasize that peripheral arterial occlusive disease is essentially a two-limb problem. Especially patients with previous ipsilateral critical ischemia and patients with a poor initial contralateral ankle/brachial index have a high risk for contralateral critical ischemia.