A meta-analysis of the outcome of endovascular and non-invasive therapies in the treatment of intermittent claudication

Ahimastos, Anna A., Wimberley, Elise P., Buttner, Petra G., Walker, Philip J., Kingwell, Bronwyn A. and Golledge, Jonathan (2011) A meta-analysis of the outcome of endovascular and non-invasive therapies in the treatment of intermittent claudication. Journal of Vascular Surgery, 54 5: 1511-1521. doi:10.1016/j.jvs.2011.06.106


Author Ahimastos, Anna A.
Wimberley, Elise P.
Buttner, Petra G.
Walker, Philip J.
Kingwell, Bronwyn A.
Golledge, Jonathan
Title A meta-analysis of the outcome of endovascular and non-invasive therapies in the treatment of intermittent claudication
Journal name Journal of Vascular Surgery   Check publisher's open access policy
ISSN 0741-5214
1097-6809
Publication date 2011-06
Sub-type Article (original research)
DOI 10.1016/j.jvs.2011.06.106
Volume 54
Issue 5
Start page 1511
End page 1521
Total pages 11
Place of publication Philadelphia, PA, United States
Publisher Mosby
Collection year 2012
Language eng
Formatted abstract
Purpose:
Intermittent claudication is a common symptom of peripheral arterial disease. Currently, there is a lack of consensus on the most effective therapies for this problem. We conducted a meta-analysis of randomized trials assessing the efficacy of endovascular therapy (EVT) compared with noninvasive therapies for the treatment of intermittent claudication.

Methods:

Randomized trials comparing the efficacy of EVT and noninvasive therapies, such as medical therapy (MT) and supervised exercise (SVE) in patients with intermittent claudication were identified by a systematic search. Data were pooled, and combined overall effect sizes (standardized differences of mean values) were calculated for a random effect model in terms of ankle-brachial index (ABI) and treadmill walking for initial claudication distance (ICD) and maximum walking distance (MWD). Nine eligible trials (873 participants) were included: two compared EVT and MT alone, four compared EVT and SVE, and three trials compared EVT plus SVE vs SVE alone.

Results:
Heterogeneity between studies was marked. Quantitative data analysis suggested that EVT improved outcomes over MT alone at early follow-up evaluations. Outcomes of EVT plus SVE were better than those of SVE alone in terms of both ABI and treadmill walking at immediate, early, and intermediate follow-up. No substantial differences in outcomes of EVT alone compared with SVE alone were found.

Conclusion:
In patients with intermittent claudication, current evidence supports improved ABI and treadmill walking when EVT is added to MT or SVE during early and intermediate follow-up. There is no evidence that EVT alone provides improved outcome over SVE alone. There is low confidence in these findings for a number of reasons, including the small number of trials, the small size of these studies, the heterogeneity in study design, and the limited use of quality of life tools in assessing outcomes. More consistent data from larger, more homogenous studies, including longer follow-up, are required.
Keyword Peripheral arterial-disease
Randomized controlled-trial
Quality-of-life
Percutaneous transluminal angioplasty
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
Official 2012 Collection
School of Medicine Publications
 
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Created: Wed, 28 Sep 2011, 12:20:19 EST by Professor Philip Walker on behalf of Surgery - Royal Brisbane and Women's Hospital