Neuropathy is Associated with Increased Risk of Amputation, Revascularization, and Death in Patients with Peripheral Vascular Disease
Lucas Hunter1, Aiden Wiley1, Glen Mckinney1, Timothy Craven1, Matthew Corriere2, Matthew Edwards1, Matthew Goldman1
1Atrium Health Wake Forest Baptist, Winston-Salem, NC;2University of Michigan, Ann Arbor, MI
BACKGROUND: Peripheral neuropathy is associated with amputation risk among patients with diabetes mellitus and critical limb threatening ischemia (CLTI). The association of neuropathy and adverse limb events has not been clearly defined in patients with peripheral arterial disease (PAD) without diabetes mellitus or in those patients with intermittent claudication.
METHODS: Patients referred to vascular surgery clinic for PAD were recruited from a single center. Exclusion criteria were a documented history of neuropathy or prior lower limb amputation. Screening utilized the Michigan Neuropathy Screening Instrument (MNSI). Scores >2 were considered abnormal and scores >4 were considered positive for peripheral neuropathy. Limb-specific outcomes of amputation and revascularization as well as a composite outcome including death were modeled using time to event analysis.
RESULTS: 86 patients were recruited. Mean age was 67±10.2 years, 30% were women, 24% were black. Mean ankle brachial index (ABI) was 0.74±0.3. PAD symptoms at initial evaluation were claudication in 52% of patients and CLTI in 38% of patients. Neuropathy was present in 20% of the cohort with a significantly higher proportion in diabetics (34% vs. 3%; p=0.0009). Neuropathy was more common in patients with CLTI compared to claudicants (36% vs. 9%;p=0.011). Forty patients (47%) reached the composite outcome of amputation, revascularization, or death with a median time to event of 16 months. Abnormal MNSI examination was significantly associated with the increased risk of the composite outcome (HR=3.19; p 0.0005)(Figure 1).
CONCLUSIONS: A significant proportion of patients presenting to vascular specialists for PAD have undiagnosed neuropathy. Patients with PAD and neuropathy have an increased risk of amputation, revascularization, and death. Expanding neuropathy screening in vascular surgery clinic visits may help to identify patients at higher risk. 
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