Vascular pathology prevalence and presentation patterns in patients presenting with leg pain to a tertiary vascular surgery clinic: A cross-sectional observational study

Abstract

Aim: Lower extremity pain is a common complaint with diverse etiologies. This study aimed to determine the prevalence of vascular pathology among patients presenting with leg pain to a tertiary vascular surgery clinic and to evaluate patterns of presentation in a resource-limited region.

Materials and Methods: This cross-sectional observational study included 152 consecutive patients aged ≥18 years who presented with primary complaint of leg pain to the Cardiovascular Surgery outpatient clinic. All patients underwent bilateral arterial and venous Doppler ultrasonography. Vascular pathology was defined as the presence of peripheral artery disease (PAD) and/or chronic venous insufficiency (CVI). Referral status, clinical characteristics, and physical examination findings were recorded.

Results: Vascular pathology was identified in 82 patients (53.9%; 95% CI: 46.0-61.7), with CVI predominant (46.7%; 95% CI: 39.0-54.6) and peripheral artery disease less common (7.9%; 95% CI: 4.6-13.3). Notably, 70 patients (46.1%) had no vascular disease. The majority of patients (92.8%) presented directly without referral from primary care. Patients with vascular pathology were significantly older (45.3±15.0 vs. 36.7±13.9 years, p<0.001), had higher body mass index (27.5±4.5 vs. 25.8±4.0 kg/m², p=0.008), and exhibited higher rates of diabetes mellitus (20.7% vs. 7.1%, p=0.032) and hypertension (20.7% vs. 5.7%, p=0.015). Physical examination findings, including pulse loss, cold extremity, and edema, were significantly more common in patients with vascular pathology (all p<0.05). Multivariable analysis revealed that none of the cardiovascular risk factors remained independently associated with vascular pathology after adjustment.

Conclusion: Nearly half of patients presenting with leg pain at a tertiary vascular surgery clinic lack vascular pathology, and the vast majority bypass primary care referral systems. These findings highlight that a substantial proportion of tertiary vascular surgery consultations may be manageable at the primary care level, suggesting a potential benefit from strengthening primary care screening capacity and developing clinical pathways to guide appropriate referrals.