Intermittent Claudication: Clinical Effectiveness of Endovascular Revascularization versus Supervised Hospital-based Exercise Training—Randomized Controlled Trial

Spronk, Sandra; Bosch, Johanna L.; Hoed, P.T. den; Veen, Hermanus F; Pattynama, Peter M. T.; Hunink, M. G. Myriam

doi:10.1148/radiol.2501080607

Cited by 136 publications

(108 citation statements)

References 36 publications

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“…19 In a randomized controlled trial of patients with PAD and intermittent claudication, supervised exercise for 24 weeks was as effective as percutaneous lower limb revascularization in increasing walking distance and improving quality of life. 20 Patients who underwent percutaneous revascularization had symptomatic benefit shortly after starting treatment, but higher rates of recurrence of intermittent claudication in the contralateral limb. On the other hand, patients randomized to supervised exercise experienced symptomatic benefit later during the follow-up period.…”

mentioning

confidence: 97%

Arterial dysfunction and functional performance in patients with peripheral artery disease: A review

2011

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Functional performance influences quality of life in individuals with peripheral artery disease (PAD) and is also a powerful prognostic marker in these patients. The pathophysiology of impaired functional performance in patients with PAD is incompletely understood. The severity of atherosclerotic burden, non-invasively assessed by the ankle-brachial index (ABI), does not reliably predict the degree of functional impairment observed in PAD patients. We review associations of measures of arterial function (arterial stiffness and endothelial dysfunction) with functional performance in PAD patients, and also review potential therapies for arterial stiffness and endothelial dysfunction that could improve functional performance in PAD. Recent studies suggest that measures of arterial function, such as arterial stiffness and endothelial function, are associated with exercise performance in the setting of PAD. These studies have provided new insights into (1) the pathophysiology of functional impairment in PAD, (2) mechanisms of strategies known to be effective such as walking programs, and (3) potential new therapeutic interventions for improving functional performance. Thus, therapies aimed at arterial 'de-stiffening' and improving endothelial function (such as aerobic exercise, statins and angiotensinconverting enzyme inhibitors) may improve functional performance in patients with PAD; however, further investigations are needed.

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confidence: 97%

Arterial dysfunction and functional performance in patients with peripheral artery disease: A review

2011

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“…Though revascularization and aggressive medical therapy have both been shown to reduce symptoms of claudication, only medical therapy has been shown to reduce morbidity and mortality related to vascular events. [11][12][13][14][15] The intention of this study is to assess the quality of medical therapy in patients who receive percutaneous interventions for the indication of lifestyle-limiting claudication and to quantify the association of preintervention medical therapy with clinical outcomes in the 6 months after the intervention.…”

mentioning

confidence: 99%

The Quality and Impact of Risk Factor Control in Patients With Stable Claudication Presenting for Peripheral Vascular Interventions

Ardati

Kaufman

Aronow

et al. 2012

Circ: Cardiovascular Interventions

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Background— Peripheral arterial disease is a manifestation of systemic atherosclerosis and is predictive of future cardiovascular events. Clinical trial data have demonstrated that medical therapy can attenuate cardiovascular morbidity and mortality in patients with peripheral arterial disease. The utilization and impact of recommended medical therapy in a contemporary population of patients who undergo percutaneous interventions for lifestyle-limiting peripheral arterial disease is unknown. Methods and Results— Using the Blue Cross Blue Shield of Michigan Cardiovascular Consortium Peripheral Vascular Intervention (BMC2 PVI) database, we identified 1357 peripheral vascular intervention encounters between January 2007 and December 2009 for the purpose of treating claudication. Before the intervention, 85% of these patients used aspirin, 76% used statin, 65% abstained from smoking, and 47% did all 3. There was no difference in cardiovascular events among those taking an aspirin and a statin on admission and those who were not. However, in both an unadjusted and a multivariable analysis, the odds of an adverse peripheral vascular outcome (repeat peripheral intervention, amputation, or limb salvage surgery) within 6 months decreased by more than half in patients receiving aspirin and statin therapy before peripheral vascular intervention as compared with those who received neither (odds ratio, 0.45; 95% CI, 0.29–0.71). Conclusions— The fundamental elements of medical therapy in patients with lifestyle-limiting claudication are often underutilized before referral for revascularization. Appropriate medical therapy before percutaneous revascularization is associated with fewer peripheral vascular events at 6 months.

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“…While revascularization is mandatory in patients with critical limb ischemia (CLI) [4], the evidence of long-term benefit of prophylactic revascularization over supervised exercise and best medical treatment is inconclusive [48]. Revascularization is indicated in patients with lifestyle-limiting claudication when clinical features suggest a reasonable likelihood of symptomatic improvement and there has been an inadequate response to conservative therapy.…”

Section: Treatment Of Lower Limb Disease In Patients With Coronary Armentioning

confidence: 99%

Multisite Atherosclerotic Disease: State of Art and Review of Literature

Noi¹,

Brancati²,

Burzotta³

et al. 2013

J Clin Exp Cardiolog

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Intermittent Claudication: Clinical Effectiveness of Endovascular Revascularization versus Supervised Hospital-based Exercise Training—Randomized Controlled Trial

Abstract: After 6 and 12 months, patients with intermittent claudication benefited equally from either endovascular revascularization or supervised exercise. Improvement was, however, more immediate after revascularization.

Cited by 136 publications

References 36 publications

Arterial dysfunction and functional performance in patients with peripheral artery disease: A review

Arterial dysfunction and functional performance in patients with peripheral artery disease: A review

The Quality and Impact of Risk Factor Control in Patients With Stable Claudication Presenting for Peripheral Vascular Interventions

Multisite Atherosclerotic Disease: State of Art and Review of Literature

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