Treatment Efficacy of Intermittent Claudication by Surgical Intervention, Supervised Physical Exercise Training Compared to No Treatment in Unselected Randomised Patients I: One Year Results of Functional and Physiological Improvements

Gélin, J; Jivegård, Lennart; Taft, Charles; Karlsson, Jenny; Sullivan, Marianne; Dahllöf, Ann‐Gret; Sandström, Rolf; Arfvidsson, Berndt; Lundholm, Kent

doi:10.1053/ejvs.2001.1413

Cited by 104 publications

(67 citation statements)

References 33 publications

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“…42 A review of randomized controlled trials suggests that the evidence favoring exercise training outweighs that for peripheral angioplasty in improving exercise tolerance in claudication patients. 43 In contrast, a direct comparison of invasive treatment and supervised exercise training found improvement at 1 year only in the invasively treated patients, 44 so the issue remains controversial. In addition, no trials have examined the effect of exercise training on the need for revascularization or on subsequent cardiovascular events or mortality in patients with claudication.…”

Section: Treatment For Patients With Peripheral Arterial Disease and mentioning

confidence: 99%

Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease

Thompson¹,

Buchner²,

Piña³

et al. 2003

Circulation

1,730

432

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Section: Treatment For Patients With Peripheral Arterial Disease and mentioning

confidence: 99%

Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease

Thompson¹,

Buchner²,

Piña³

et al. 2003

Circulation

1,730

432

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“…9 We previously demonstrated a low compliance to our supervised program, which had clinical results similar to those that involved training advice. 32 Finally, because we included claudicants referred to a vascular surgeon for clinical assessment, we cannot exclude that the patients randomized to invasive treatment were inherently more satisfied with their treatment group allocation, and this may represent a potential bias.…”

Section: Discussionmentioning

confidence: 99%

Improved Quality of Life After 1 Year With an Invasive Versus a Noninvasive Treatment Strategy in Claudicants

et al. 2014

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I ntermittent claudication (IC) is the most common symptomatic presentation in peripheral arterial disease, and ≈20 to 40 million individuals in the world experience classic IC symptoms.1 IC may also cause a substantial loss of walking function and thereby reduce health-related quality of life (HRQoL). As a manifestation of atherosclerosis, IC confers an increased risk for cardiovascular and cerebrovascular events and premature death. 2,3 This risk can be modified by medical intervention, and the leg symptoms can be reduced by exercise; thus, the generally accepted first-line treatment in patients with IC is risk factor modification, medical treatment, and exercise training. 4,5 Exercise training under supervision of a physiotherapist is often recommended because this approach has been shown to provide better short-term results (6-12 months) than with structured training advice alone. 6,7 However, current practice is different. Supervised exercise training programs are largely unavailable in most countries; hence, the majority of claudicants in Europe do not receive this treatment option. 8 Furthermore, a recent systematic review (National Institute for Health and Clinical Excellence) showed uncertain and probably very poor compliance to supervised training. 9 Health-economic modeling demonstrated that supervised training is cost-effective only when HRQoL results are extrapolated beyond the end of existing trial data and under the assumption of activity-induced benefits in terms of mortality and cardiovascular events. Editorial see p 929 Clinical Perspective on p 947Background-The quality of evidence for invasive revascularization in intermittent claudication is low or very low. This prospective, randomized, controlled study tested the hypothesis that an invasive treatment strategy versus continued noninvasive treatment improves health-related quality of life after 1 year in unselected patients with intermittent claudication. Methods and Results-After clinical and duplex ultrasound assessment, unselected patients with intermittent claudication requesting treatment for claudication were randomly assigned to invasive (n=79) or noninvasive (n=79) treatment groups. The quality of evidence for invasive interventions in IC is still low or very low.9 Most available studies evaluating invasive treatment have used rather selective inclusion criteria, enrolling patients with vascular lesions (eg, in specific vessel segments, of a certain length and severity, and with suitable anatomy for endovascular treatment). [10][11][12][13] The low proportion of all referred claudicants included in most IC interventional trials makes it difficult to generalize results to the majority of IC patients.14 In this context, we sought to perform a "real world" study to test the hypothesis that an invasive (surgical or endovascular) treatment strategy compared with continued medical therapy improves HRQoL in relatively unselected IC patients receiving best medical treatment and structured (nonsupervised) training advice. Methods General Des...

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“…For example, between 1995 and 2000 over 3000 such bypasses were recorded in the Swedish Vascular Registry (Swedvasc). In the largest randomized study of intervention in claudicants, surgery improved walking distance and quality of life signi®cantly more than supervised exercise or controls 8,9 . Furthermore, no excess mortality or limb loss was found in the surgery group and ankle arterial pressure was signi®cantly increased following intervention.…”

Section: Surgerymentioning

confidence: 98%

Untitled

2002

Br J Surg

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Treatment Efficacy of Intermittent Claudication by Surgical Intervention, Supervised Physical Exercise Training Compared to No Treatment in Unselected Randomised Patients I: One Year Results of Functional and Physiological Improvements

Abstract: invasive treatment increased walking capacity, leg blood pressure and flow. Supervised physical exercise training offered no therapeutic advantage compared to untreated controls.

Cited by 104 publications

References 33 publications

Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease

Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease

Improved Quality of Life After 1 Year With an Invasive Versus a Noninvasive Treatment Strategy in Claudicants

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