Absence of Long-Term Benefit of Revascularization in Patients With Intermittent Claudication

Abstract

Low risk of procedure-related major amputation following revascularization for intermittent claudication-a population based study Eur J Vasc Endovasc Surg.

Lower Extremity Peripheral Artery Disease: Contemporary Epidemiology, Management Gaps, and Future Directions: A Scientific Statement From the American Heart Association

“…These recommendations are based on data showing that there is a relatively low likelihood of limb loss associated with mild PAD 189 and that long-term improvements in symptomatology may be limited. 190 For example, recent data from the Invasive Revascularization or Not in Intermittent Claudication trial demonstrated that, after 5 years of follow-up, revascularization for claudication lost any early benefit and did not result in long-term health-related quality of life compared with best medical therapy. 190 Despite guidelines recommending medical management as the first-line therapy for claudication, recent registry data from the Vascular Quality Initiative demonstrate that 27% of all open bypass procedures and even a higher percentage of endovascular interventions are performed for claudication.…”

“…190 For example, recent data from the Invasive Revascularization or Not in Intermittent Claudication trial demonstrated that, after 5 years of follow-up, revascularization for claudication lost any early benefit and did not result in long-term health-related quality of life compared with best medical therapy. 190 Despite guidelines recommending medical management as the first-line therapy for claudication, recent registry data from the Vascular Quality Initiative demonstrate that 27% of all open bypass procedures and even a higher percentage of endovascular interventions are performed for claudication. 191 It is possible that many of the patients undergoing revascularization for claudication experienced severe claudication symptoms and that conservative management failed.…”

Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the American Society for Preventive Cardiology Part II: Physical activity, cardiorespiratory fitness, minimum and goal intensities for exercise training, prescriptive methods, and special patient populations

“…Additionally, the IRONIC trial compared revascularization versus SET in addition to optimal medical therapy, and initial follow-up at 1- and 2-years reported improved health-related QOL only in the revascularization group. However, after 5-years of follow-up, the revascularization strategy versus SET plus optimal medical therapy yielded comparable improvements in health-related QOL [141] . In the recent CLEVER trial, SET and endovascular therapy, when combined with optimal medical therapy, were associated with greater improvements in functional outcomes compared with optimal medical therapy alone with no difference in therapeutic efficacy between SET vs. endovascular therapy [142] .…”

Lower Extremity Peripheral Artery Disease Without Chronic Limb-Threatening Ischemia

“…Although endovascular revascularization immediately improves walking ability, supervised exercise requires regular adherence to 3-times-weekly exercise to attain improvement after approximately 6 to 8 weeks of exercise . Patients should be educated about these differences and advised that 25% to 30% of endovascular treatments fail within 5 years and that lower extremity revascularization, but not exercise, is associated with acute limb ischemia . Furthermore, lower extremity revascularization does not reduce rates of coronary events or stroke.…”