A systematic review of treatment of intermittent claudication in the lower extremities

Rafael D. Malgor, Fares Alalahdab, Tarig A. Elraiyah, Adnan Z. Rizvi, Melanie A. Lane, Larry J. Prokop, Olivia J. Phung, Wigdan Farah, Victor Manuel Montori, Michael S. Conte, Mohammad H Murad

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Background Peripheral arterial disease is common and is associated with significant morbidity and mortality. Methods We conducted a systematic review to identify randomized trials and systematic reviews of patients with intermittent claudication to evaluate surgery, endovascular therapy, and exercise therapy. Outcomes of interest were death, amputation, walking distance, quality of life, measures of blood flow, and cost. Results We included eight systematic reviews and 12 trials enrolling 1548 patients. Data on mortality and amputation and on cost-effectiveness were sparse. Compared with medical management, each of the three treatments (surgery, endovascular therapy, and exercise therapy) was associated with improved walking distance, claudication symptoms, and quality of life (high-quality evidence). Evidence supporting superiority of one of the three approaches was limited. However, blood flow parameters improved faster and better with both forms of revascularization compared with exercise or medical management (low- to moderate-quality evidence). Compared with endovascular therapy, open surgery may be associated with longer length of hospital stay and higher complication rate but resulted in more durable patency (moderate-quality evidence). Conclusions In patients with claudication, open surgery, endovascular therapy, and exercise therapy were superior to medical management in terms of walking distance and claudication. Choice of therapy should rely on patients' values and preferences, clinical context, and availability of operative expertise.

Original languageEnglish (US)
Pages (from-to)54S-73S
JournalJournal of Vascular Surgery
Volume61
Issue number3
DOIs
StatePublished - Mar 1 2015

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Intermittent Claudication
Lower Extremity
Exercise Therapy
Walking
Quality of Life
Amputation
Length of Stay
Therapeutics
Mortality
Patient Preference
Peripheral Arterial Disease
Cost-Benefit Analysis
Exercise
Morbidity
Costs and Cost Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Malgor, R. D., Alalahdab, F., Elraiyah, T. A., Rizvi, A. Z., Lane, M. A., Prokop, L. J., ... Murad, M. H. (2015). A systematic review of treatment of intermittent claudication in the lower extremities. Journal of Vascular Surgery, 61(3), 54S-73S. https://doi.org/10.1016/j.jvs.2014.12.007

A systematic review of treatment of intermittent claudication in the lower extremities. / Malgor, Rafael D.; Alalahdab, Fares; Elraiyah, Tarig A.; Rizvi, Adnan Z.; Lane, Melanie A.; Prokop, Larry J.; Phung, Olivia J.; Farah, Wigdan; Montori, Victor Manuel; Conte, Michael S.; Murad, Mohammad H.

In: Journal of Vascular Surgery, Vol. 61, No. 3, 01.03.2015, p. 54S-73S.

Research output: Contribution to journalArticle

Malgor, RD, Alalahdab, F, Elraiyah, TA, Rizvi, AZ, Lane, MA, Prokop, LJ, Phung, OJ, Farah, W, Montori, VM, Conte, MS & Murad, MH 2015, 'A systematic review of treatment of intermittent claudication in the lower extremities', Journal of Vascular Surgery, vol. 61, no. 3, pp. 54S-73S. https://doi.org/10.1016/j.jvs.2014.12.007
Malgor RD, Alalahdab F, Elraiyah TA, Rizvi AZ, Lane MA, Prokop LJ et al. A systematic review of treatment of intermittent claudication in the lower extremities. Journal of Vascular Surgery. 2015 Mar 1;61(3):54S-73S. https://doi.org/10.1016/j.jvs.2014.12.007
Malgor, Rafael D. ; Alalahdab, Fares ; Elraiyah, Tarig A. ; Rizvi, Adnan Z. ; Lane, Melanie A. ; Prokop, Larry J. ; Phung, Olivia J. ; Farah, Wigdan ; Montori, Victor Manuel ; Conte, Michael S. ; Murad, Mohammad H. / A systematic review of treatment of intermittent claudication in the lower extremities. In: Journal of Vascular Surgery. 2015 ; Vol. 61, No. 3. pp. 54S-73S.
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