Early Outcomes From a Randomized, Controlled Trial of Supervised Exercise, Angioplasty, and Combined Therapy in Intermittent Claudication

Background

To compare angioplasty (PTA), supervised exercise (SEP) and PTA+SEP in the treatment of intermittent claudication (IC) due to femoropopliteal disease

Methods

Over a 6-year period, 178 patients (108 men; median age, 70 years) with femoropopliteal lesions suitable for angioplasty were randomized to PTA, SEP, or PTA+SEP. Patients were assessed prior to and at 1 and 3 months post treatment. ISCVS outcome criteria (ankle pressures, treadmill walking distances) and quality of life (QoL) questionnaires (SF-36 and VascuQoL) were analyzed.

Results

All groups were well matched at baseline. Twenty-one patients withdrew. Results are as follows: Intragroup analysis: All groups demonstrated significant clinical and QoL improvements (Friedman test, p<0.05). SEP (60 patients, 8 withdrew)—62.7% of patients (n=32) improved following treatment [20 mild, 9 moderate, 3 marked], 27.4% (n=14) demonstrated no improvement, and 9.8% (n=5) deteriorated. PTA (60 patients, 3 withdrew)—66.6% patients (n=38) improved following treatment [19 mild, 10 moderate, 9 marked], 22.8% (n=13) demonstrated no improvement, and 10.5% (n=6) deteriorated. PTA+SEP (58 patients, 10 withdrew)—81.6% of patients (n=40) improved following treatment [10 mild, 17 moderate, 3 marked], 14.2% (n=7) demonstrated no improvement, and 4.0% (n=2) deteriorated. Intergroup analysis: PTA+SEP produce a much greater improvement in clinical outcome measures than PTA or SEP alone, but there was no significant QoL advantage (Kruskal-Wallis test, p>0.05).

Conclusion

SEP should be the primary treatment for the patients with claudication and PTA should be supplemented by an SEP.