Systematic review of exercise training or percutaneous transluminal angioplasty for intermittent claudication

Abstract

As IC is a common healthcare problem, defining the optimal treatment strategy is important. A combination of PTA and exercise (SET or ET advice) may be superior to exercise or PTA alone, but this needs to be confirmed.

The Role of Supervised Exercise Therapy in Peripheral Arterial Obstructive Disease

“…Unfortunately these guidelines may seem outdated. Results described above one could conclude that, in general, the effectiveness of PTA and SET was equivalent, although PTA plus SET improved walking distance and some domains of QoL scales compared with SET or PTA alone (35). Evidence to use a combination of PTA and SET for patients with IC complaints is still inconclusive.…”

“…In summary, SET with additional PTA gave the best improvement in Maximal Walking Distance (MWD), Initial Claudication Distance (ICD) and Ankle Brachial Index (ABI) (35). Changes in MWD, ICD and ABI between PTA alone and SET alone were equivocal, either comparabl e o r i n f a v o u r o f P T A .…”

“…A recent systematic review compared (S)ET with percutaneous transluminal angioplasty (PTA) in patients with intermittent claudication (IC) to obtain the best estimates of their relative effectiveness (35). Eleven studies (reporting data on eight randomized clinical trials) met the inclusion criteria.…”

“…The systematic review additionally included five trials that studied combined lesions (35). In summary, PTA plus SET compared with PTA alone demonstrated an improvement in MWD.…”

ISPD Cardiovascular and Metabolic Guidelines in Adult Peritoneal Dialysis Patients Part II – Management of Various Cardiovascular Complications

“…This threshold has been reported to have a sensitivity of 95% and a specificity of 100% for PAD detection in patients without CKD, although there are no studies examining the sensitivity and specificity of ABI in PD (or hemodialysis or CKD) patients specifically. Using ABI has been recommended for general population screening in at-risk patients by the American College of Cardiology (ACC)/AHA (45,46) RATIONALE: Exercise therapy has been found in general PAD patient populations with intermittent claudication to have equivalent effectiveness to percutaneous luminal angioplasty in a meta-analysis of 8 randomized controlled trials (48) and to produce significantly improved walking time, pain-free walking distance, and maximum walking distance (but not mortality, amputation, peak exercise calf blood flow or ABI) compared with usual care or placebo in a meta-analysis of 22 trials involving 1,200 participants (49). There are no randomized controlled trials testing the efficacy of exercise therapy in CKD patients with PAD.…”