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Long-Term Outcomes of Exercise Therapy Versus Revascularization in Patients With Intermittent Claudication.
Takuro Shirasu1,2, Hisato Takagi3, Jun Yasuhara4
1Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA.
Annals of Surgery
|February 2, 2023
Summary
For intermittent claudication (IC), invasive revascularization offers no significant difference in progression to chronic limb-threatening ischemia (CLTI) or amputation compared to noninvasive therapy. However, invasive treatments lead to more procedures, supporting noninvasive therapy as a first-line option.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Public Health
Background:
- Conflicting evidence exists regarding the optimal treatment strategy for intermittent claudication (IC).
- Adverse limb outcomes, including progression to chronic limb-threatening ischemia (CLTI) and amputation, are critical considerations in treatment decisions.
Purpose of the Study:
- To compare the risks of CLTI progression, amputation, and subsequent interventions between revascularization and noninvasive therapy in patients with IC.
- To evaluate the long-term limb outcomes and mortality associated with invasive versus noninvasive treatment strategies for IC.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Searched MEDLINE, Web of Science, and Google Scholar for RCTs comparing invasive (endovascular or surgical revascularization) with noninvasive (exercise and/or medical treatment) therapies for IC.
- Included 9 RCTs with 1477 patients, analyzing outcomes including CLTI progression, amputation, and all-cause mortality over a mean follow-up of 3.6 years.
Main Results:
- No statistically significant difference in the risk of progression to CLTI between invasive and noninvasive treatment groups (rate ratio: 0.77; P =0.51).
- Incidence of amputation and all-cause mortality did not differ significantly between the treatment groups.
- Patients undergoing invasive treatment had a significantly higher number of revascularization procedures (rate ratio: 4.15; P <0.00001).
Conclusions:
- Invasive revascularization for IC does not reduce the risk of CLTI progression, major amputation, or all-cause mortality compared to noninvasive therapy.
- The higher rate of revascularization procedures in the invasive group suggests a need for selective application in patients with significant lifestyle limitations.
- Findings support current guideline recommendations for noninvasive treatment as the first-line therapy for intermittent claudication.
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