Intermittent Claudication and Asymptomatic Peripheral Arterial Disease.

Area of Science:

• Vascular Surgery
• Cardiology
• Rehabilitation Medicine

Background:

• Current guidelines recommend conservative management for peripheral arterial disease (PAD), including lifestyle changes and risk factor control.
• For intermittent claudication (IC), initial treatment involves medication and supervised gait training (SGT).
• Revascularization is reserved for critical ischemia, not asymptomatic patients.

Purpose of the Study:

• To evaluate the availability and effectiveness of various treatment strategies for IC in Germany.
• To compare conservative treatments with revascularization in managing IC.
• To assess the adherence to guidelines in the German healthcare system for IC treatment.

Main Methods:

• A comprehensive literature search was conducted by the German Society for Angiology in 2014, updated in 2018.
• The review focused on treatment options, their efficacy, and their real-world application in Germany.
• Evidence levels and recommendation grades were considered for treatment modalities.

Main Results:

• Lifestyle modification and risk factor treatment have strong evidence (Level I, Grade A).
• Drug therapy offers moderate improvement in walking distance (Level IIb).
• Supervised exercise training (SET) shows limited efficacy, availability, and compliance despite strong evidence (Level I, Grade A).
• Revascularization provides faster symptom relief and improving long-term benefits in IC patients.
• Combined arterial revascularization and gait training yielded the best outcomes, significantly increasing pain-free walking distance.

Conclusions:

• Revascularization is emerging as a more effective treatment for vasogenic IC than SET and perfusion-enhancing drugs.
• Supervised exercise training (SET) appears to be largely absent from the German healthcare system.
• Increased availability and utilization of SET are desirable for long-term revascularization benefits and cardiovascular risk reduction.