Long-Term Outcomes of Invasive vs Noninvasive Treatment for Intermittent Claudication: A Systematic Review and...

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Peripheral Arterial Disease Management

Background:

• Intermittent claudication (IC) is a primary symptom of peripheral arterial disease (PAD), characterized by leg pain during activity due to reduced blood flow.
• IC significantly impacts patient mobility and quality of life (QoL).
• Treatment options range from conservative best medical therapy (BMT) and supervised exercise therapy (SET) to invasive procedures like angioplasty and re-vascularization.

Purpose of the Study:

• To systematically review and meta-analyze the long-term outcomes of invasive interventions versus noninvasive treatments for managing IC.
• To compare the efficacy and safety profiles of different treatment modalities for IC.

Main Methods:

• A comprehensive systematic search was performed across major databases (PubMed, MEDLINE, Cochrane Library, Embase, Scopus) in October 2024.
• Included randomized controlled trials (RCTs) comparing invasive and noninvasive treatments for IC.
• Primary outcomes included QoL, ankle-brachial pressure index (ABPI), and maximum walking distance (MWD); secondary outcomes included MACE, mortality, complications, and re-intervention rates. Follow-up was 2-7 years.

Main Results:

• Invasive treatments showed significant improvements in MWD and ABPI compared to noninvasive methods.
• While invasive interventions had a higher complication rate, including amputation risk, this was not statistically significant.
• Long-term adverse event rates were higher in the noninvasive treatment group.

Conclusions:

• Both invasive and noninvasive treatments effectively manage IC, with invasive methods offering superior improvements in walking distance and blood flow.
• The increased risk of complications and re-interventions with invasive procedures requires careful consideration.
• Further research with larger sample sizes and longer follow-up is recommended to evaluate cost-effectiveness and long-term outcomes.