PMID- 36728522
OWN - NLM
STAT- MEDLINE
DCOM- 20230712
LR  - 20230718
IS  - 1528-1140 (Electronic)
IS  - 0003-4932 (Linking)
VI  - 278
IP  - 2
DP  - 2023 Aug 1
TI  - Long-Term Outcomes of Exercise Therapy Versus Revascularization in Patients With 
      Intermittent Claudication.
PG  - 172-178
LID - 10.1097/SLA.0000000000005793 [doi]
AB  - OBJECTIVE: The aim was to analyze the risk of progression to chronic 
      limb-threatening ischemia (CLTI), amputation and subsequent interventions after 
      revascularization versus noninvasive therapy in patients with intermittent 
      claudication (IC). BACKGROUND: Conflicting evidence exists regarding adverse limb 
      outcomes after each treatment strategy. METHODS: Preferred Reporting Items for 
      Systematic Reviews and Meta-Analyses guidelines were followed. MEDLINE, Web of 
      Science, and Google Scholar were searched aided by a health sciences librarian 
      through August 16, 2022. Randomized control trials (RCTs) comparing invasive 
      (endovascular or surgical revascularization) and noninvasive treatment (exercise 
      and/or medical treatment) were included. PROSPERO registration was completed 
      (CRD42022352831). RESULTS: A total of 9 RCTs comprising 1477 patients (invasive, 
      765 patients; noninvasive, 712 patients) were eligible. During a mean of 3.6-year 
      follow-up, progression to CLTI after invasive [5 (2-8) per 1000 person-years] and 
      noninvasive treatment [6 (3-10) per 1000 person-years] were not statistically 
      different [rate ratio (RR): 0.77; 95% CI, 0.35-1.69; P =0.51, I2 =0%]. Incidence 
      of amputation (RR: 1.69; 95% CI, 0.54-5.26; P =0.36, I2 =0%) and all-cause 
      mortality (hazard ratio: 1.26; 95% CI, 0.91-1.74; P =0.16, I2 =0%) also did not 
      differ between the groups. However, the invasive treatment group underwent 
      significantly more revascularizations (RR: 4.15; 95% CI, 2.80-6.16; P <0.00001, 
      I2 =83%). The results were not changed by fixed effect or random-effects models, 
      nor by sensitivity analysis. CONCLUSIONS: Although there is equivalent risk of 
      progression to CLTI, major amputation and all-cause mortality compared with 
      noninvasive treatment, invasive treatment for patients with IC led to 
      significantly more revascularization procedures and should be used selectively in 
      patients with major lifestyle limitation. Guideline recommendation of noninvasive 
      treatment for first-line IC therapy is supported.
CI  - Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Shirasu, Takuro
AU  - Shirasu T
AUID- ORCID: 0000-0002-3598-4068
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, University 
      of Virginia Health System, Charlottesville, VA.
AD  - Division of Vascular Surgery, Department of Surgery, The University of Tokyo, 
      Tokyo, Japan.
FAU - Takagi, Hisato
AU  - Takagi H
AD  - Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
FAU - Yasuhara, Jun
AU  - Yasuhara J
AD  - Center for Cardiovascular Research, The Abigail Wexner Research Institute and The 
      Heart Center, Nationwide Children's Hospital, Columbus, OH.
FAU - Kuno, Toshiki
AU  - Kuno T
AD  - Department of Cardiology, Montefiore Medical Center, Albert Einstein Medical 
      College, New York, NY.
FAU - Kent, K Craig
AU  - Kent KC
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, University 
      of Virginia Health System, Charlottesville, VA.
FAU - Farivar, Behzad S
AU  - Farivar BS
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, University 
      of Virginia Health System, Charlottesville, VA.
FAU - Tracci, Margaret C
AU  - Tracci MC
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, University 
      of Virginia Health System, Charlottesville, VA.
FAU - Clouse, W Darrin
AU  - Clouse WD
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, University 
      of Virginia Health System, Charlottesville, VA.
LA  - eng
PT  - Journal Article
PT  - Systematic Review
DEP - 20230103
PL  - United States
TA  - Ann Surg
JT  - Annals of surgery
JID - 0372354
SB  - IM
MH  - Humans
MH  - *Endovascular Procedures/adverse effects
MH  - Exercise Therapy
MH  - Intermittent Claudication/surgery/etiology
MH  - Ischemia/etiology
MH  - *Peripheral Arterial Disease/complications/surgery
MH  - Risk Factors
MH  - Treatment Outcome
MH  - Vascular Surgical Procedures/adverse effects
MH  - Randomized Controlled Trials as Topic
COIS- The authors report no conflicts of interest.
EDAT- 2023/02/03 06:00
MHDA- 2023/07/12 06:42
CRDT- 2023/02/02 09:13
PHST- 2023/07/12 06:42 [medline]
PHST- 2023/02/03 06:00 [pubmed]
PHST- 2023/02/02 09:13 [entrez]
AID - 00000658-202308000-00005 [pii]
AID - 10.1097/SLA.0000000000005793 [doi]
PST - ppublish
SO  - Ann Surg. 2023 Aug 1;278(2):172-178. doi: 10.1097/SLA.0000000000005793. Epub 2023 
      Jan 3.