Document Detail


Intermittent claudication: clinical effectiveness of endovascular revascularization versus supervised hospital-based exercise training--randomized controlled trial.
MedLine Citation:
PMID:  19188327     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To compare clinical success, functional capacity, and quality of life during 12 months after revascularization or supervised exercise training in patients with intermittent claudication. MATERIALS AND METHODS: This study had institutional review board approval, and all patients gave written informed consent. Between September 2002 and September 2005, 151 consecutive patients who presented with symptoms of intermittent claudication were randomly assigned to undergo either endovascular revascularization (angioplasty-first approach) (n = 76) or hospital-based supervised exercise (n = 75). The outcome measures were clinical success, functional capacity, and quality of life after 6 and 12 months. Clinical success was defined as improvement in at least one category in the Rutherford scale above the pretreatment level. Significance of differences between the groups was assessed with the unpaired t test, chi(2) test, or Mann-Whitney U test. To adjust outcomes for imbalances of baseline values, multivariable regression analysis was performed. RESULTS: Immediately after the start of treatment, patients who underwent revascularization improved more than patients who performed exercise in terms of clinical success (adjusted odds ratio [OR], 39; 99% confidence interval [CI]: 11, 131; P < .001), but this advantage was lost after 6 (adjusted OR, 0.9; 99% CI: 0.3, 2.3; P = .70) and 12 (adjusted OR, 1.1; 99% CI: 0.5, 2.8; P = .73) months. After revascularization, fewer patients showed signs of ipsilateral symptoms at 6 months compared with patients in the exercise group (adjusted OR, 0.4; 99% CI: 0.2, 0.9; P < .001), but no significant differences were demonstrated at 12 months. After both treatments, functional capacity and quality of life scores increased after 6 and 12 months, but no significant differences between the groups were demonstrated. CONCLUSION: After 6 and 12 months, patients with intermittent claudication benefited equally from either endovascular revascularization or supervised exercise. Improvement was, however, more immediate after revascularization.
Authors:
Sandra Spronk; Johanna L Bosch; Pieter T den Hoed; Hermanus F Veen; Peter M T Pattynama; M G Myriam Hunink
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Radiology     Volume:  250     ISSN:  1527-1315     ISO Abbreviation:  Radiology     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-02-03     Completed Date:  2009-03-10     Revised Date:  2010-09-01    
Medline Journal Info:
Nlm Unique ID:  0401260     Medline TA:  Radiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  586-95     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Vascular Laboratory, Ikazia Hospital, Rotterdam, the Netherlands. s.spronk@erasmusmc.nl
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon*
Chi-Square Distribution
Exercise Therapy*
Female
Humans
Intermittent Claudication / physiopathology,  therapy*
Male
Quality of Life
Radiography, Interventional
Recovery of Function
Regression Analysis
Statistics, Nonparametric
Stents*
Treatment Outcome
Comments/Corrections
Comment In:
Radiology. 2010 Sep;256(3):1011; author reply 1011-2   [PMID:  20720082 ]
Erratum In:
Radiology. 2010 Sep;256(3):1016

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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