This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Long‐term clinical effectiveness of supervised exercise therapy versus endovascular revascularization for intermittent claudication from a randomized clinical trial. BJS 2013; 100: 1164-1171.

Published: 10th July 2013

Authors: F. Fakhry, E. V. Rouwet, P. T. den Hoed, M. G. M. Hunink, S. Spronk

Background

Long‐term comparisons of supervised exercise therapy (SET) and endovascular revascularization (ER) for patients with intermittent claudication are scarce. The long‐term clinical effectiveness of SET and ER was assessed in patients from a randomized trial.

Method

Consenting patients with intermittent claudication were assigned randomly to either SET or ER. Outcome measures on functional performance (pain‐free and maximum walking distance, ankle : brachial pressure index), quality of life (QoL) and number of secondary interventions were measured at baseline and after approximately 7 years of follow‐up. Repeated‐measurement and Kaplan–Meier methods were used to analyse the data on an intention‐to treat‐basis.

Results

A total of 151 patients were randomized initially to either SET or ER. After 7 years, functional performance (P < 0·001) and QoL (P ≤ 0·005) had improved after both SET and ER. Long‐term comparison showed no differences between the two treatments, except in the secondary intervention rate, which was significantly higher after SET (P = 0·001). Nevertheless, the total number of endovascular and surgical interventions (primary and secondary) remained higher after ER (P < 0·001).

Conclusion

In the longer term, SET‐first or ER‐first treatment strategies were equally effective in improving functional performance and QoL in patients with intermittent claudication. The substantially higher number of invasive interventions in the ER‐first group supports a SET‐first treatment strategy for intermittent claudication. Registration number: NTR199 (http://www.trialregister.nl).

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