Comparative Efficacy of Endovascular Revascularization Versus Supervised Exercise Training in Patients With Intermittent Claudication

Pandey, Ambarish; Banerjee, Subhash; Ngo, Christian; Mody, Purav; Marso, Steven P.; Brilakis, Emmanouil S.; Armstrong, Ehrin J.; Giri, Jay; Bonaca, Marc P.; Pradhan, Aruna D.; Bavry, Anthony A.; Kumbhani, Dharam J.

doi:10.1016/j.jcin.2017.01.027

Cited by 68 publications

(50 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Exercise training combined with revascularisation procedures is the cornerstone in the treatment and prevention of progression in PAD. 181,182 Antithrombotic therapy based on combination therapies may play an important role in the prevention of death, ischaemic cardiovascular and limb events in patients with lower extremity PAD. In the COMPASS trial, 183 a low dose (2.5 mg twice a day) of NOAC rivaroxaban plus aspirin (100 mg once a day) -as compared to aspirin alone -was shown to reduce the composite endpoint of cardiovascular death, MI, or stroke (HR 0.72, 95% CI 0.57-0.90; P ¼ 0.0047) and major adverse limb events including major amputation (HR 0.54, 95% CI 0.35-0.82; P ¼ 0.0037) among patients with previous peripheral bypass surgery or angioplasty, limb or foot amputation, intermittent claudication, carotid or CAD with an ABI of less than 0.90.…”

Section: Peripheral Arterial Diseasementioning

confidence: 99%

Update on cardiovascular prevention in clinical practice: A position paper of the European Association of Preventive Cardiology of the European Society of Cardiology

Piepoli

Abreu

Albus

et al. 2019

Eur J Prev Cardiolog

181

View full text Add to dashboard Cite

European guidelines on cardiovascular prevention in clinical practice were first published in 1994 and have been regularly updated, most recently in 2016, by the Sixth European Joint Task Force. Given the amount of new information that has become available since then, components from the task force and experts from the European Association of Preventive Cardiology of the European Society of Cardiology were invited to provide a summary and critical review of the most important new studies and evidence since the latest guidelines were published. The structure of the document follows that of the previous document and has six parts: Introduction (epidemiology and cost effectiveness); Cardiovascular risk; How to intervene at the population level; How to intervene at the individual level; Disease-specific interventions; and Settings: where to intervene? In fact, in keeping with the guidelines, greater emphasis has been put on a population-based approach and on disease-specific interventions, avoiding re-interpretation of information already and previously considered. Finally, the presence of several gaps in the knowledge is highlighted.

show abstract

Section: Peripheral Arterial Diseasementioning

confidence: 99%

Update on cardiovascular prevention in clinical practice: A position paper of the European Association of Preventive Cardiology of the European Society of Cardiology

Piepoli

Abreu

Albus

et al. 2019

Eur J Prev Cardiolog

181

View full text Add to dashboard Cite

show abstract

“…Most studies (23 studies on 1433 patients) supported improved amputation incidence or levels for patients with severe PAD. A meta‐analysis of seven RCTs comparing the efficacy of SET alone to ER, with or without SET, reported lower risk of future revascularisation or amputation for ER with SET as compared to SET alone . Another meta‐analysis of three RCTs reported reduced amputations for patients with severe PAD treated with ER as compared to bypass surgery .…”

Section: Resultsmentioning

confidence: 99%

“…A meta-analysis of seven RCTs comparing the efficacy of SET alone to ER, with or without SET, reported lower risk of future revascularisation or amputation for ER with SET as compared to SET alone. 97 Another meta-analysis 27 of three RCTs reported reduced amputations for patients with severe PAD treated with ER as compared to bypass surgery. [98][99][100] In one of the three RCTs, 101 patients who received bypass surgery before ER had increased longterm survival if they survived the first 2 years after the bypass, suggesting that bypass surgery may reduce longterm mortality, without significantly affecting overall mortality, amputation-free survival, or health-related QOL.…”

Section: Reducing Likelihood Of Limb Amputations (24 Studies On 153mentioning

confidence: 99%

Peripheral arterial disease: Scoping review of patient‐centred outcomes

Bolton

2019

International Wound Journal

View full text Add to dashboard Cite

Peripheral arterial disease (PAD) impairs patients' quality of life (QOL), walking and ulcer healing, increasing patient pain, costs, and risks of amputation or mortality. A literature appraisal described PAD treatment capacity to improve validated patient-centred outcomes in controlled clinical studies. The PUBMED database was searched from 1 January 1970 to 21 June 2018, for original and derivative controlled clinical trial references addressing MeSH terms for 'ischemia' AND 'leg ulcer'. Non-ischemic ulcer treatment references were excluded. Frequencies of improved (P < .05) outcomes were reported. Eighty-eight studies on 4153 patients were summarized. Walking, pain or QOL improved mainly for interventions administered before PAD became severe. Amputation incidence, pain and ulcer healing were more frequently reported in those with severe PAD. Independent of PAD severity, patients experienced more likely improved walking, QOL, or pain reduction in response to structured walking interventions or those increasing calf muscle activity. Those with more severe PAD were more likely to report amputation reduction, mainly in response to invasive interventions. Those with PAD experienced more consistently improved patient-centred outcomes if they received multidisciplinary PAD management with supervised walking or calf muscle activity, with more likely amputation risk reduced for those with more severe PAD. Key Messages• Peripheral arterial disease (PAD) progresses in severity from impaired walking and quality of life (QOL) through increasing likelihood of pain, ulceration, gangrene, amputation, or death and magnifies clinical, economic, and patient burdens of venous insufficiency or diabetes • improving PAD-related patient-centred outcomes requires consistent early, effective PAD diagnosis and effective treatment to improve lower limb perfusionAbbreviations: ABI, ankle-to-brachial systolic blood pressure index (ratio), optimally performed using handheld Doppler ultrasound; ALU, arterial leg ulcers; CLI, critical limb ischaemia; DAPT, dual antiplatelet therapy, for example, aspirin plus low molecular weight heparin; DFU, diabetic foot ulcers; ER, endovascular revascularisation; HBO, hyperbaric oxygen; IC, intermittent claudication; IPC, intermittent pneumatic compression of the calf muscle; MLU, mixed aetiology leg ulcers complicated with peripheral arterial disease; NMES, neuromuscular electrical stimulation sufficient to cause contraction of the calf muscle; PAD, peripheral arterial disease; PPG, photoplethysmography a technique for measuring venous emptying; QOL, quality of life; RCT, randomised clinical trial; SET, structured exercise therapy supervised by a professional; SOC, standard of care; TcPO 2 , transcutaneous partial pressure of oxygen; VLU, venous leg ulcer.

show abstract

“…Compared with supervised exercise testing alone, patients with intermittent claudication who undergo both endovascular therapy and supervised exercise testing achieve greater maximal walk distance and less repeat revascularization or amputation (5). OR = odds ratio; WMD = weighted mean difference.…”

Section: Figurementioning

confidence: 99%

“…In this issue of JACC: Cardiovascular Interventions , Pandey et al (5) report on a meta-analysis in patients with peripheral artery disease designed to compare the benefit of revascularization, primarily by endovascular techniques, over the well-proven effects of supervised exercise training. Their analysis is divided into 2 comparisons: first, supervised exercise training alone versus revascularization alone, and second, supervised exercise training after revascularization versus supervised exercise training alone.…”

mentioning

confidence: 99%