Endovascular revascularisation versus conservative management for intermittent claudication

Endovascular revascularisation alone appears not to provide significant benefit over supervised exercise therapy alone, but combination of endovascular revascularisation plus supervised exercise may be superior to supervised exercise alone in the treatment of intermittent claudication.

The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals).

Summary

A Cochrane review included 10 studies with a total of 1 087 subjects with intermittent claudication. The studies compared endovascular revascularisation with no specific treatment or conservative therapy, or a combination of endovascular revascularisation plus conservative therapy with conservative therapy alone. Conservative treatment consisted of supervised exercise or pharmacotherapy with cilostazol 100 mg twice daily.

Endovascular revascularisation compared with no specific treatment except advice to exercise (3 studies, n=134): Endovascular revascularisation increased walking distances in the short term (maximum walking distance (MWD) SMD 0.70, 95% CI 0.31 to 1.08; 3 studies, n=125 and pain-free walking distance (PFWD) SMD 1.29, 95% CI 0.90 to 1.68; 3 studies, n=125), but not after long-term follow up (2 studies, n=103). The number of additional surgical procedures was not different between groups (2 studies, n=118), and there was no differences in disease-specific quality of life after 2 years (1 study). Endovascular revascularisation compared with supervised exercise (5 studies, n=412): No differences were observed in improvement of walking distances, number of additional surgical procedures, and quality of life. Combination therapy of endovascular revascularisation plus supervised exercise versus supervised exercise alone (3 studies, n=457): There was no differences for walking distances in the short term or in disease-specific quality of life. One study (n=106) showed a large effect on maximum walking distance (MWD) in favour of combination therapy over the long term (SMD 1.18, 95% CI 0.65 to 1.70), and the number of additional surgical procedures was lower following combination therapy (OR 0.27, 95% CI 0.13 to 0.55; 3 studies, n=457). Combination therapy of endovascular revascularisation plus drug therapy with cilostazol versus drug therapy alone (2 studies, n=199): There was small to moderate effects on walking distance and on quality of life in favour of the combination therapy, but no difference in the number of additional surgical procedures.