Intermittent Claudication—Surgical Reconstruction or Physical Training?

Abstract

This study reports the initial evaluation of treatment efficiency in 75 patients with intermittent claudication who were randomized to three treatment groups: 1) reconstructive surgery, 2) reconstructive surgery with subsequent physical training, and 3) physical training alone. Before treatment, there were no statistically significant differences between the groups in age, sex, smoking habits, symptom duration of claudication, ankle-arm blood pressure quotient (ankle-index), maximal plethysmographic calf blood flow, symptom-free and maximal walking distance, the history of other atherosclerotic manifestations or in the medical treatment. The walking performance was improved in all three groups at follow-up 13 +/- 0.5 months after randomization. Surgery was most effective, but the addition of training to surgery improved the symptom-free walking distance even further. In pooled observations of the three groups, age, symptom duration, and a history of myocardial ischemic disease correlated negatively with walking performance after treatment. In the operated group, the duration of claudication and a history of myocardial ischemic disease correlated negatively with the walking performance. This was not the case when patients were censored if limited by other symptoms than intermittent claudication after treatment. In the trained group, the duration of claudication correlated negatively to symptom-free and maximal walking distance. Ankle-index and maximal plethysmographic calf blood flow after treatment and the change of these variables with treatment correlated positively with both symptom-free and maximal walking distance when results were pooled for all patients. Although this mainly was a consequence of the improved blood flow after surgery, the change of maximal plethysmographic calf blood flow also correlated with symptom-free but not with maximal walking distance in the trained group. The results demonstrate that, compared with physical training alone, operation alone or in combination with subsequent training are superior treatment modalities in patients with intermittent claudication.

The effects of exercise training in patients with peripheral vascular disease - a review

“…29 Similarly, in other studies, this group did report improvements in MWD and PFWD in patients with intermittent claudication following exercise training.…”

“…A wide variety of treadmill walking tests have been used to quantify improvements in walking distances and functional capacity following training in patients with intermittent claudication (Table I). 8,19,28,29,30,41 REvIEW ARTIClE …”

“…Since this study a number of randomised controlled trials (Table I) have shown similar results. 8,19,22,23,25,29,30,35,36,41,44 It is clear from Table I that exercise training improves walking tolerance in patients with PVD. Indeed when comparing the effects of exercise training with PTA, exercise training was more beneficial after a 6-month period.…”

Peripheral Arterial Disease—What Do We Need to Know?

“…25 A meta-analysis that included only randomized trials showed that exercise produced a significant increase in maximum walking time with this benefit being greater than with angioplasty or bypass surgery. 26 Exercise therapy has several limitations, including lack of motivation from both patients and physicians, lack of coverage by medical insurance, and failure to adhere to the exercise regimen with time.…”

The Role of Supervised Exercise Therapy in Peripheral Arterial Obstructive Disease

“…Only one RCT compared SET to surgical reconstruction (38). This study reported the initial evaluation of treatment efficiency in 75 patients with IC who were randomized to three treatment groups: 1) reconstructive surgery, 2) reconstructive surgery with subsequent physical training, and 3) physical training alone.…”