Repetitive low-grade inflammatory events in claudicants lead to elevation of serum acute-phase proteins. Exercise training is associated with symptomatic improvement and reduction inflammatory markers. The concern that exercise has adverse systemic effects therefore seems to be unjustified.
SA carries a low risk of major complications and high immediate technical success. Poor long-term patency suggests that SA is not as durable as bypass surgery. However, failed SA did not compromise subsequent surgery, which only became necessary in a proportion of patients. Our data suggests that there is little to be lost by using SA as first-line treatment for patients with limb-threatening ischaemia who are poor operative risks or who have no autologous vein available.
Further studies are needed to determine the effect of long-term exercise training on exercise-induced inflammation in claudication. Early work suggests, in fact, that exercise attenuates this inflammatory response. If this were confirmed then it would support the clinical impression that exercise training is beneficial in terms of symptomatic improvement and cardiovascular health in patients with intermittent claudication.
In centers with an operative mortality rate of greater than 2%, (1) surgical intervention is not indicated for asymptomatic AAAs of less than 4.5 cm in diameter, and (2) elective surgery should be considered only for patients with aneurysms between 4.5 and 6 cm in diameter that are expanding by more than 1 cm per year or for patients in whom symptoms develop. In centers with elective mortality rates of greater than 10% for abdominal aortic aneurysm (AAA) repair, the benefit to the patient of any surgical intervention for an asymptomatic AAA of less than 6.0 cm in diameter is questionable.
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