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Objective: Supervised exercise therapy (SET) is recommended as the primary treatment for intermittent claudication (IC). Despite convincing data supporting the efficacy of SET as an initial treatment, implementation in clinical practice remains challenging. The aim of this study was to determine the primary treatment (SET, endovascular revascularization [ER], and open surgery) in relation to secondary lower limb revascularization and survival in patients with IC.Methods: Retrospective data analysis was performed using the national health insurance claims of all newly diagnosed IC patients in The Netherlands between January 2013 and December 2017. Analysis included Kaplan-Meier method and Cox proportional hazards regression models with adjustment for multiple confounders.Results: The 5-year cohort included 54,504 IC patients (primary SET, n ¼ 39,476; primary ER, n ¼ 11,769; and primary open surgery, n ¼ 3259). SET as primary treatment increased from 63% in 2013 to 87% in 2017. Patients who underwent ER or open surgery as a primary treatment had a higher risk of secondary revascularizations (hazard ratio [

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