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Combined endovascular therapy, exercise training improves functional outcomes
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In patients with peripheral artery disease and intermittent claudication, endovascular therapy combined with supervised exercise training, compared with initial supervised exercise training only, improved functional outcomes and reduced risk for subsequent revascularization or amputation, according to data from a meta-analysis.
The researchers included 987 patients from seven randomized controlled trials in their study. In pooled analysis, they found a higher maximum walk distance among those who underwent combined endovascular therapy and supervised exercise training vs. supervised exercise training only (standardized mean difference, 0.79; 95% CI, 0.18-1.39), with a weighted mean difference of 98.9 feet (95% CI, 31.4-166.4).
During a median follow-up of 12.4 months, results also linked combined endovascular therapy and supervised exercise training to a lower risk for revascularization or amputation, as compared with supervised exercise training only (OR = 0.19; 95% CI, 0.09-0.4).
Additionally, ankle-brachial index was higher on follow-up with combined endovascular therapy and supervised exercise training than with supervised exercise therapy only (standardized mean difference, 0.62; 95% CI, 0.33-0.91), with a weighted mean difference of 0.14 (95% CI, 0.1-0.17).
When comparing endovascular therapy only with supervised exercise training only, the researchers observed no significant differences between groups in maximum walk distance, ischemic claudication distance or risk for revascularization or amputation. Ankle-brachial index, however, was significantly higher in the endovascular therapy-only group (standardized mean difference, 0.64; 95% CI, 0.38-0.9).
“These findings highlight the need to consider initial revascularization as an adjunctive therapy to supervised exercise training but not as a primary treatment option in the initial management approaches for intermittent claudication,” the researchers wrote. “Future studies that have longer-term follow-up, compare contemporary revascularization techniques and exercise training protocols, and are adequately powered to assess relevant clinical outcomes, are needed to determine the most effective management strategies for these patients.” – by Melissa Foster
Disclosure: Various researchers report receiving speakers’ honoraria, research support and/or consultant or personal fees from Abbott Vascular, American College of Cardiology, Aralez, Asahi, AstraZeneca, Bayer, Boston Scientific, Cardinal Health, Cardiovascular Systems Inc., Elsevier, GE Healthcare, InfraRedx, Medtronic, Merck, Novo Nordisk, Spectranetics, St. Jude Medical, The Medicines Company and W.L. Gore and Associates.
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