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Gornik HL, Aronow HD, Goodney PP, Arya S, Brewster LP, Byrd L, Chandra V, Drachman DE, Eaves JM, Ehrman JK, Evans JN, Getchius TSD, Gutiérrez JA, Hawkins BM, Hess CN, Ho KJ, Jones WS, Kim ESH, Kinlay S, Kirksey L, Kohlman-Trigoboff D, Long CA, Pollak AW, Sabri SS, Sadwin LB, Secemsky EA, Serhal M, Shishehbor MH, Treat-Jacobson D, Wilkins LR. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:2497-2604. [PMID: 38752899 DOI: 10.1016/j.jacc.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
AIM The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia). METHODS A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate. STRUCTURE Recommendations from the "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed.
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Gornik HL, Aronow HD, Goodney PP, Arya S, Brewster LP, Byrd L, Chandra V, Drachman DE, Eaves JM, Ehrman JK, Evans JN, Getchius TSD, Gutiérrez JA, Hawkins BM, Hess CN, Ho KJ, Jones WS, Kim ESH, Kinlay S, Kirksey L, Kohlman-Trigoboff D, Long CA, Pollak AW, Sabri SS, Sadwin LB, Secemsky EA, Serhal M, Shishehbor MH, Treat-Jacobson D, Wilkins LR. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1313-e1410. [PMID: 38743805 DOI: 10.1161/cir.0000000000001251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
AIM The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia). METHODS A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate. STRUCTURE Recommendations from the "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed.
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Morosetti D, Chiocchi M, Argirò R, Salimei F, Nezzo M, Vidali S, Gasparrini F, Meloni M, Uccioli L, Gandini R. Endovascular treatment of calcific lesions of the common femoral artery using atherectomy device associated with scoring balloon angioplasty in diabetic patients with high "major amputation" risk. Vascular 2021; 30:463-473. [PMID: 34056973 DOI: 10.1177/17085381211019244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the outcomes of patients with calcific lesions in the common femoral artery undergoing endovascular procedures with atherectomy device and scoring balloon angioplasty combined with treatment of steno-occlusive disease of the remaining arterial districts of the lower limb. METHODS Between January 2015 and December 2018, 11 diabetic patients at high risk for "major amputation", with calcific lesions of the common femoral artery and ischemic ulcers requiring endovascular treatment were retrospectively evaluated. Technical success was defined as revascularization of the common femoral artery with a residual stenosis lower than 30%. Primary endpoints were an immediate increase of perilesional transcutaneous oxygen pressure (TCPO2) > 40 mmHg, ulcerative lesions improvement up to healing or skin flaps re-epithelialization after minor amputation, limb rescue with rejected major amputation, and resolution of rest pain if present. RESULTS The success rate of the revascularization procedures was 100%. No patient underwent surgical conversion. One case of peri-operative bleeding at the brachial access site was observed. There were no cases of arterial dissection or undesired distal embolization. The average baseline value of perilesional TCPO2 was 21.8 ± 9.2 mmHg. The mean TCPO2 value was 57.4 ± 7.2 mmHg three days after the procedure (P < 0.05), and 51.2 ± 9.8 mmHg 15 days after (P < 0.05). Minor amputations were performed in five patients with advanced ulcerative lesions. No major amputations were performed in the follow-up period. At 14 months follow-up, one patient developed new occlusion of the CFA for extension from the external iliac artery and underwent a new endovascular procedure. We observed an overall primary patency rate of 91% and a primary assisted patency rate of 100% in our 18-month follow-up. CONCLUSIONS Endovascular approach for severely calcified atherosclerotic lesions of the common femoral artery seems to represent a valid therapeutic option associated with promising results in terms of clinical outcome and low complication rates.
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Affiliation(s)
- Daniele Morosetti
- UOSD Radiologia Interventistica, University Hospital Policlinico Tor Vergata, Roma, Italy
| | - Marcello Chiocchi
- UOC Diagnostica per Immagini, University Hospital Policlinico Tor Vergata, Roma, Italy
| | - Renato Argirò
- UOSD Radiologia Interventistica, University Hospital Policlinico Tor Vergata, Roma, Italy
| | - Fabio Salimei
- UOSD Radiologia Interventistica, University Hospital Policlinico Tor Vergata, Roma, Italy
| | - Marco Nezzo
- UOSD Radiologia Interventistica, University Hospital Policlinico Tor Vergata, Roma, Italy
| | - Sofia Vidali
- UOSD Radiologia Interventistica, University Hospital Policlinico Tor Vergata, Roma, Italy
| | - Fulvio Gasparrini
- UOSD Radiologia Interventistica, University Hospital Policlinico Tor Vergata, Roma, Italy
| | - Marco Meloni
- Diabetic foot Unit, University Hospital Policlinico Tor Vergata, Roma, Italy
| | - Luigi Uccioli
- Diabetic foot Unit, University Hospital Policlinico Tor Vergata, Roma, Italy
| | - Roberto Gandini
- UOSD Radiologia Interventistica, University Hospital Policlinico Tor Vergata, Roma, Italy
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Jung KS, Heo SH, Woo SY, Park YJ, Kim DI, Kim YW. Factors associated with long-term graft patency after lower extremity arterial bypasses. Ann Surg Treat Res 2021; 100:175-185. [PMID: 33748031 PMCID: PMC7943280 DOI: 10.4174/astr.2021.100.3.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/18/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose This study was conducted to determine factors associated with long-term graft patency after lower extremity arterial bypass (LEAB). Methods Database of LEABs for patients with chronic arterial occlusive disease (CAOD) at a single institution was retrospectively reviewed. To determine the factors we compared demographic, clinical, and procedural variables between 2 patient groups; group I (graft patency < 2 years) and group II (graft patency ≥ 5 years after LEAB) using univariable and multivariable analyses. Results Among 957 LEABs, 259 limbs (group I, 125 limbs and group II, 134 limbs) in 213 patients were included for the analysis. On a univariable analysis, younger age (69 years vs. 66 years, P = 0.024), hypertension (60.8% vs. 74.6%, P = 0.017), claudication (51.2% vs. 70.9%, P = 0.001), absence of prior intervention (50.4% vs. 73.9%, P < 0.001), common femoral artery based bypass (57.6% vs. 70.1%, P = 0.035), above-the knee bypass (36.8% vs. 64.2%, P < 0.001), postoperative graft salvage procedure (3.2% vs. 14.8%, P = 0.001), and statin use (75.2% vs. 88.8, P = 0.004) were associated with long-term patency. On a multivariate analysis hypertension (odds ratio [OR], 1.91; P = 0.038), claudication (OR, 2.08; P = 0.032), no prior intervention (OR, 2.48; P = 0.001), vein graft (OR, 4.36; P = 0.001), above-the knee bypass (OR, 4.68; P < 0.001), and graft salvage procedures (OR, 7.70; P < 0.001) were identified as independent factors. Conclusion These factors can be considered in decision making before treatment of patients with CAOD.
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Affiliation(s)
- Ki-Sang Jung
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seon-Hee Heo
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin-Young Woo
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abola MTB, Golledge J, Miyata T, Rha SW, Yan BP, Dy TC, Ganzon MSV, Handa PK, Harris S, Zhisheng J, Pinjala R, Robless PA, Yokoi H, Alajar EB, Bermudez-delos Santos AA, Llanes EJB, Obrado-Nabablit GM, Pestaño NS, Punzalan FE, Tumanan-Mendoza B. Asia-Pacific Consensus Statement on the Management of Peripheral Artery Disease: A Report from the Asian Pacific Society of Atherosclerosis and Vascular Disease Asia-Pacific Peripheral Artery Disease Consensus Statement Project Committee. J Atheroscler Thromb 2020; 27:809-907. [PMID: 32624554 PMCID: PMC7458790 DOI: 10.5551/jat.53660] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/01/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Peripheral artery disease (PAD) is the most underdiagnosed, underestimated and undertreated of the atherosclerotic vascular diseases despite its poor prognosis. There may be racial or contextual differences in the Asia-Pacific region as to epidemiology, availability of diagnostic and therapeutic modalities, and even patient treatment response. The Asian Pacific Society of Atherosclerosis and Vascular Diseases (APSAVD) thus coordinated the development of an Asia-Pacific Consensus Statement (APCS) on the Management of PAD. OBJECTIVES The APSAVD aimed to accomplish the following: 1) determine the applicability of the 2016 AHA/ACC guidelines on the Management of Patients with Lower Extremity Peripheral Artery Disease to the Asia-Pacific region; 2) review Asia-Pacific literature; and 3) increase the awareness of PAD. METHODOLOGY A Steering Committee was organized to oversee development of the APCS, appoint a Technical Working Group (TWG) and Consensus Panel (CP). The TWG appraised the relevance of the 2016 AHA/ACC PAD Guideline and proposed recommendations which were reviewed by the CP using a modified Delphi technique. RESULTS A total of 91 recommendations were generated covering history and physical examination, diagnosis, and treatment of PAD-3 new recommendations, 31 adaptations and 57 adopted statements. This Asia-Pacific Consensus Statement on the Management of PAD constitutes the first for the Asia-Pacific Region. It is intended for use by health practitioners involved in preventing, diagnosing and treating patients with PAD and ultimately the patients and their families themselves.
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Affiliation(s)
- Maria Teresa B Abola
- Department of Clinical Research, Philippine Heart Center and University of the Philippines College of Medicine, Metro Manila, Philippines
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, and Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia
| | - Tetsuro Miyata
- Vascular Center, Sanno Hospital and Sanno Medical Center, Tokyo, Japan
| | - Seung-Woon Rha
- Dept of Cardiology, Internal Medicine, College of Medicine, Korea University; Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea
| | - Bryan P Yan
- Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Timothy C Dy
- The Heart Institute, Chinese General Hospital and Medical Center, Manila, Philippines
| | | | | | - Salim Harris
- Neurovascular and Neurosonology Division, Neurology Department, Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | | | | | | | - Hiroyoshi Yokoi
- Cardiovascular Center, Fukuoka Sanno Hospital; International University of Health and Welfare, Fukuoka, Japan
| | - Elaine B Alajar
- Section of Cardiology, Department of Internal Medicine, Manila Doctors Hospital; University of the Philippines College of Medicine, Manila, Philippines
| | | | - Elmer Jasper B Llanes
- Division of Cardiology, Department of Medicine, College of Medicine, University of the Philippines Philippine General Hospital, Manila, Philippines
| | | | - Noemi S Pestaño
- Section of Cardiology, Department of Internal Medicine, Manila Doctors Hospital, Manila, Philippines
| | - Felix Eduardo Punzalan
- Division of Cardiology, Department of Medicine, College of Medicine, University of the Philippines; Philippine General Hospital, Manila, Philippines
| | - Bernadette Tumanan-Mendoza
- Department of Clinical Epidemiology, University of the Philippines College of Medicine, Manila, Philippines
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Bolton L. Peripheral arterial disease: Scoping review of patient-centred outcomes. Int Wound J 2019; 16:1521-1532. [PMID: 31597226 DOI: 10.1111/iwj.13232] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/04/2019] [Accepted: 09/13/2019] [Indexed: 01/13/2023] Open
Abstract
Peripheral arterial disease (PAD) impairs patients' quality of life (QOL), walking and ulcer healing, increasing patient pain, costs, and risks of amputation or mortality. A literature appraisal described PAD treatment capacity to improve validated patient-centred outcomes in controlled clinical studies. The PUBMED database was searched from 1 January 1970 to 21 June 2018, for original and derivative controlled clinical trial references addressing MeSH terms for 'ischemia' AND 'leg ulcer'. Non-ischemic ulcer treatment references were excluded. Frequencies of improved (P < .05) outcomes were reported. Eighty-eight studies on 4153 patients were summarized. Walking, pain or QOL improved mainly for interventions administered before PAD became severe. Amputation incidence, pain and ulcer healing were more frequently reported in those with severe PAD. Independent of PAD severity, patients experienced more likely improved walking, QOL, or pain reduction in response to structured walking interventions or those increasing calf muscle activity. Those with more severe PAD were more likely to report amputation reduction, mainly in response to invasive interventions. Those with PAD experienced more consistently improved patient-centred outcomes if they received multidisciplinary PAD management with supervised walking or calf muscle activity, with more likely amputation risk reduced for those with more severe PAD.
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Affiliation(s)
- Laura Bolton
- Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey
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7
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Mizzi A, Cassar K, Bowen C, Formosa C. The progression rate of peripheral arterial disease in patients with intermittent claudication: a systematic review. J Foot Ankle Res 2019; 12:40. [PMID: 31404410 PMCID: PMC6683562 DOI: 10.1186/s13047-019-0351-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/29/2019] [Indexed: 12/17/2022] Open
Abstract
Background Intermittent claudication (IC) is the most common symptom of peripheral arterial disease and is generally treated conservatively due to limited prognostic evidence to support early revascularisation in the individual patient. This approach may lead to the possible loss of opportunity of early revascularisation in patients who are more likely to deteriorate to critical limb ischaemia. The aim of this review is to evaluate the available literature related to the progression rate of symptomatic peripheral arterial disease. Methods We conducted a systematic review of the literature in PubMed and MEDLINE, Cochrane library, Elsevier, Web of Science, CINAHL and Opengrey using relevant search terms to identify the progression rate of peripheral arterial disease in patients with claudication. Outcomes of interest were progression rate in terms of haemodynamic measurement and time to development of adverse outcomes. Two independent reviewers determined study eligibility and extracted descriptive, methodologic, and outcome data. Quality of evidence was evaluated using the Cochrane recommendations for assessing risk of bias and was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Seven prospective cohort studies and one retrospective cohort study were identified and included in this review with the number of participants in each study ranging from 38 to 1244. Progression rate reports varied from a yearly decrease of 0.01 in ankle-brachial pressure index (ABPI) to a yearly decrease ABPI of 0.014 in 21% of participants. Quality of evidence ranged from low to moderate mostly due to limited allocation concealment at recruitment and survival selection bias. Conclusions Progression of PAD in IC patients is probably underestimated in the literature due to study design issues. Predicting which patients with claudication are likely to deteriorate to critical limb ischaemia is difficult since there is a lack of evidence related to lower limb prognosis. Further research is required to enable early identification of patients at high risk of progressing to critical ischaemia and appropriate early revascularisation to reduce lower limb morbidity.
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Affiliation(s)
- A Mizzi
- 1Faculty of Health Sciences, University of Malta, Msida, Malta
| | - K Cassar
- Mater Dei hospital, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - C Bowen
- 3School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - C Formosa
- 1Faculty of Health Sciences, University of Malta, Msida, Malta
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8
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Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FGR, Hamburg NM, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin JW, Patel RAG, Regensteiner JG, Schanzer A, Shishehbor MH, Stewart KJ, Treat-Jacobson D, Walsh ME. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; 69:e71-e126. [PMID: 27851992 DOI: 10.1016/j.jacc.2016.11.007] [Citation(s) in RCA: 435] [Impact Index Per Article: 87.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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9
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Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FGR, Hamburg NM, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin JW, Patel RAG, Regensteiner JG, Schanzer A, Shishehbor MH, Stewart KJ, Treat-Jacobson D, Walsh ME, Halperin JL, Levine GN, Al-Khatib SM, Birtcher KK, Bozkurt B, Brindis RG, Cigarroa JE, Curtis LH, Fleisher LA, Gentile F, Gidding S, Hlatky MA, Ikonomidis J, Joglar J, Pressler SJ, Wijeysundera DN. 2016 AHA/ACC Guideline on the Management of Patients with Lower Extremity Peripheral Artery Disease: Executive Summary. Vasc Med 2018; 22:NP1-NP43. [PMID: 28494710 DOI: 10.1177/1358863x17701592] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
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- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information
| | | | - Heather L Gornik
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information
| | | | | | | | - Douglas E Drachman
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,5 Society for Cardiovascular Angiography and Interventions Representative
| | - Lee A Fleisher
- 6 ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Francis Gerry R Fowkes
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,7 Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative
| | | | - Scott Kinlay
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,8 Society for Vascular Medicine Representative
| | - Robert Lookstein
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,3 ACC/AHA Representative
| | - Sanjay Misra
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,9 Society of Interventional Radiology Representative
| | - Leila Mureebe
- 10 Society for Clinical Vascular Surgery Representative
| | - Jeffrey W Olin
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,3 ACC/AHA Representative
| | - Rajan A G Patel
- 7 Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative
| | | | - Andres Schanzer
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,11 Society for Vascular Surgery Representative
| | - Mehdi H Shishehbor
- 1 Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.,3 ACC/AHA Representative
| | - Kerry J Stewart
- 3 ACC/AHA Representative.,12 American Association of Cardiovascular and Pulmonary Rehabilitation Representative
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10
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Fowkes G, Gillespie IN. WITHDRAWN: Angioplasty (versus non surgical management) for intermittent claudication. Cochrane Database Syst Rev 2018. [PMID: 29521415 PMCID: PMC6494181 DOI: 10.1002/14651858.cd000017.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Intermittent claudication is pain in the legs due to muscle ischaemia associated with arterial stenosis or occlusion. Angioplasty is a technique that involves dilatation and recanalisation of a stenosed or occluded artery. OBJECTIVES The objective of this review was to determine the effects of angioplasty of arteries in the leg when compared with non surgical therapy, or no therapy, for people with mild to moderate intermittent claudication. SEARCH METHODS Sources searched include the Cochrane Peripheral Vascular Diseases Group's Specialized Trials Register (August 2006), the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, 2006) and reference lists of relevant articles. The review authors also contacted investigators in the field and handsearched relevant conference proceedings (August 2006). SELECTION CRITERIA Randomised trials of angioplasty for mild or moderate intermittent claudication. DATA COLLECTION AND ANALYSIS The contact author selected suitable trials and this was checked by the other review author. Both review authors assessed trial quality independently. The contact author extracted data and this was cross checked by the other review author. MAIN RESULTS Two trials with a total of 98 participants were included. The average age was 62 years old with 20 women and 78 men. Participants were followed for two years in one trial and six years in the other.At six months follow up, mean ankle brachial pressure indices were higher in the angioplasty groups than control groups (mean difference 0.17; 95% confidence interval (CI) 0.11 to 0.24). In one trial, walking distances were greater in the angioplasty group, but in the other trial, in which controls underwent an exercise programme, walking distances did not show a greater improvement in the angioplasty group. At two years follow up in one trial, the angioplasty group were more likely to have a patent artery (odds ratio 5.5; 95% CI 1.8 to 17.0) but not a significantly better walking distance or quality of life. In the other trial, long term follow up at six years demonstrated no significant differences in outcome between the angioplasty and control groups. AUTHORS' CONCLUSIONS These limited results suggest that angioplasty may have had a short term benefit, but this may not have been sustained.
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Affiliation(s)
- Gerry Fowkes
- The University of EdinburghDepartment of Public Health SciencesTeviot PlaceEdinburghUKEH8 9AG
| | - Ian N Gillespie
- New Royal Infirmary of EdinburghDepartment of RadiologyLittle FranceOld Dalkeith RoadEdinburghUKEH16 4SA
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11
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Fakhry F, Fokkenrood HJP, Spronk S, Teijink JAW, Rouwet EV, Hunink MGM. Endovascular revascularisation versus conservative management for intermittent claudication. Cochrane Database Syst Rev 2018; 2018:CD010512. [PMID: 29518253 PMCID: PMC6494207 DOI: 10.1002/14651858.cd010512.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Intermittent claudication (IC) is the classic symptomatic form of peripheral arterial disease affecting an estimated 4.5% of the general population aged 40 years and older. Patients with IC experience limitations in their ambulatory function resulting in functional disability and impaired quality of life (QoL). Endovascular revascularisation has been proposed as an effective treatment for patients with IC and is increasingly performed. OBJECTIVES The main objective of this systematic review is to summarise the (added) effects of endovascular revascularisation on functional performance and QoL in the management of IC. SEARCH METHODS For this review the Cochrane Vascular Information Specialist (CIS) searched the Specialised Register (February 2017) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 1). The CIS also searched trials registries for details of ongoing and unpublished studies. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing endovascular revascularisation (± conservative therapy consisting of supervised exercise or pharmacotherapy) versus no therapy (except advice to exercise) or versus conservative therapy (i.e. supervised exercise or pharmacotherapy) for IC. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data, and assessed the methodological quality of studies. Given large variation in the intensity of treadmill protocols to assess walking distances and use of different instruments to assess QoL, we used standardised mean difference (SMD) as treatment effect for continuous outcome measures to allow standardisation of results and calculated the pooled SMD as treatment effect size in meta-analyses. We interpreted pooled SMDs using rules of thumb (< 0.40 = small, 0.40 to 0.70 = moderate, > 0.70 = large effect) according to the Cochrane Handbook for Systematic Reviews of Interventions. We calculated the pooled treatment effect size for dichotomous outcome measures as odds ratio (OR). MAIN RESULTS We identified ten RCTs (1087 participants) assessing the value of endovascular revascularisation in the management of IC. These RCTs compared endovascular revascularisation versus no specific treatment for IC or conservative therapy or a combination therapy of endovascular revascularisation plus conservative therapy versus conservative therapy alone. In the included studies, conservative treatment consisted of supervised exercise or pharmacotherapy with cilostazol 100 mg twice daily. The quality of the evidence ranged from low to high and was downgraded mainly owing to substantial heterogeneity and small sample size.Comparing endovascular revascularisation versus no specific treatment for IC (except advice to exercise) showed a moderate effect on maximum walking distance (MWD) (SMD 0.70, 95% confidence interval (CI) 0.31 to 1.08; 3 studies; 125 participants; moderate-quality evidence) and a large effect on pain-free walking distance (PFWD) (SMD 1.29, 95% CI 0.90 to 1.68; 3 studies; 125 participants; moderate-quality evidence) in favour of endovascular revascularisation. Long-term follow-up in two studies (103 participants) showed no clear differences between groups for MWD (SMD 0.67, 95% CI -0.30 to 1.63; low-quality evidence) and PFWD (SMD 0.69, 95% CI -0.45 to 1.82; low-quality evidence). The number of secondary invasive interventions (OR 0.81, 95% CI 0.12 to 5.28; 2 studies; 118 participants; moderate-quality evidence) was also not different between groups. One study reported no differences in disease-specific QoL after two years.Data from five studies (n = 345) comparing endovascular revascularisation versus supervised exercise showed no clear differences between groups for MWD (SMD -0.42, 95% CI -0.87 to 0.04; moderate-quality evidence) and PFWD (SMD -0.05, 95% CI -0.38 to 0.29; moderate-quality evidence). Similarliy, long-term follow-up in three studies (184 participants) revealed no differences between groups for MWD (SMD -0.02, 95% CI -0.36 to 0.32; moderate-quality evidence) and PFWD (SMD 0.11, 95% CI -0.26 to 0.48; moderate-quality evidence). In addition, high-quality evidence showed no difference between groups in the number of secondary invasive interventions (OR 1.40, 95% CI 0.70 to 2.80; 4 studies; 395 participants) and in disease-specific QoL (SMD 0.18, 95% CI -0.04 to 0.41; 3 studies; 301 participants).Comparing endovascular revascularisation plus supervised exercise versus supervised exercise alone showed no clear differences between groups for MWD (SMD 0.26, 95% CI -0.13 to 0.64; 3 studies; 432 participants; moderate-quality evidence) and PFWD (SMD 0.33, 95% CI -0.26 to 0.93; 2 studies; 305 participants; moderate-quality evidence). Long-term follow-up in one study (106 participants) revealed a large effect on MWD (SMD 1.18, 95% CI 0.65 to 1.70; low-quality evidence) in favour of the combination therapy. Reports indicate that disease-specific QoL was comparable between groups (SMD 0.25, 95% CI -0.05 to 0.56; 2 studies; 330 participants; moderate-quality evidence) and that the number of secondary invasive interventions (OR 0.27, 95% CI 0.13 to 0.55; 3 studies; 457 participants; high-quality evidence) was lower following combination therapy.Two studies comparing endovascular revascularisation plus pharmacotherapy (cilostazol) versus pharmacotherapy alone provided data showing a small effect on MWD (SMD 0.38, 95% CI 0.08 to 0.68; 186 participants; high-quality evidence), a moderate effect on PFWD (SMD 0.63, 95% CI 0.33 to 0.94; 186 participants; high-quality evidence), and a moderate effect on disease-specific QoL (SMD 0.59, 95% CI 0.27 to 0.91; 170 participants; high-quality evidence) in favour of combination therapy. Long-term follow-up in one study (47 participants) revealed a moderate effect on MWD (SMD 0.72, 95% CI 0.09 to 1.36; P = 0.02) in favour of combination therapy and no clear differences in PFWD between groups (SMD 0.54, 95% CI -0.08 to 1.17; P = 0.09). The number of secondary invasive interventions was comparable between groups (OR 1.83, 95% CI 0.49 to 6.83; 199 participants; high-quality evidence). AUTHORS' CONCLUSIONS In the management of patients with IC, endovascular revascularisation does not provide significant benefits compared with supervised exercise alone in terms of improvement in functional performance or QoL. Although the number of studies is small and clinical heterogeneity underlines the need for more homogenous and larger studies, evidence suggests that a synergetic effect may occur when endovascular revascularisation is combined with a conservative therapy of supervised exercise or pharmacotherapy with cilostazol: the combination therapy seems to result in greater improvements in functional performance and in QoL scores than are seen with conservative therapy alone.
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Affiliation(s)
- Farzin Fakhry
- Erasmus MCDepartments of Epidemiology & RadiologyDr Molewaterplein 40PO Box 2040RotterdamNetherlands3015 GD
| | | | - Sandra Spronk
- Erasmus MCDepartments of Epidemiology & RadiologyDr Molewaterplein 40PO Box 2040RotterdamNetherlands3015 GD
- Dutch Health Care InspectorateDepartment of Research and InnovationUtrechtNetherlands
| | - Joep AW Teijink
- Catharina HospitalDepartment of Vascular Surgeryvisiting address: Michelangelolaan 2, 5623 EJ, Eindhovenpostal address: P.O. Box 1350EindhovenNetherlands5602 ZA
| | - Ellen V Rouwet
- Erasmus MCDepartment of Vascular SurgeryRotterdamNetherlands
| | - M G Myriam Hunink
- Erasmus MCDepartment of EpidemiologyPO Box 2040RotterdamNetherlands3000 CA
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12
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Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FGR, Hamburg NM, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin JW, Patel RAG, Regensteiner JG, Schanzer A, Shishehbor MH, Stewart KJ, Treat-Jacobson D, Walsh ME. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017; 135:e686-e725. [PMID: 27840332 PMCID: PMC5479414 DOI: 10.1161/cir.0000000000000470] [Citation(s) in RCA: 376] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines with recommendations to improve cardiovascular health. These guidelines, based on systematic methods to evaluate and classify evidence, provide a cornerstone of quality cardiovascular care. In response to reports from the Institute of Medicine1 ,2 and a mandate to evaluate new knowledge and maintain relevance at the point of care, the ACC/AHA Task Force on Clinical Practice Guidelines (Task Force) modified its methodology.3 –5 The relationships among guidelines, data standards, appropriate use criteria, and performance measures are addressed elsewhere.5
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Affiliation(s)
| | - Heather L Gornik
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Coletta Barrett
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Neal R Barshes
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Matthew A Corriere
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Douglas E Drachman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Lee A Fleisher
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Francis Gerry R Fowkes
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Naomi M Hamburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Scott Kinlay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Robert Lookstein
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Sanjay Misra
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Leila Mureebe
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Jeffrey W Olin
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Rajan A G Patel
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Judith G Regensteiner
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Andres Schanzer
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Mehdi H Shishehbor
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Kerry J Stewart
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Diane Treat-Jacobson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - M Eileen Walsh
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
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13
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Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FGR, Hamburg NM, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin JW, Patel RAG, Regensteiner JG, Schanzer A, Shishehbor MH, Stewart KJ, Treat-Jacobson D, Walsh ME. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017; 135:e726-e779. [PMID: 27840333 PMCID: PMC5477786 DOI: 10.1161/cir.0000000000000471] [Citation(s) in RCA: 378] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines with recommendations to improve cardiovascular health. These guidelines, based on systematic methods to evaluate and classify evidence, provide a cornerstone of quality cardiovascular care. In response to reports from the Institute of Medicine1 ,2 and a mandate to evaluate new knowledge and maintain relevance at the point of care, the ACC/AHA Task Force on Clinical Practice Guidelines (Task Force) modified its methodology.3 –5 The relationships among guidelines, data standards, appropriate use criteria, and performance measures are addressed elsewhere.5
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Affiliation(s)
| | - Heather L Gornik
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Coletta Barrett
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Neal R Barshes
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Matthew A Corriere
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Douglas E Drachman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Lee A Fleisher
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Francis Gerry R Fowkes
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Naomi M Hamburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Scott Kinlay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Robert Lookstein
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Sanjay Misra
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Leila Mureebe
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Jeffrey W Olin
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Rajan A G Patel
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Judith G Regensteiner
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Andres Schanzer
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Mehdi H Shishehbor
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Kerry J Stewart
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - Diane Treat-Jacobson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
| | - M Eileen Walsh
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. Functioning as the lay volunteer/patient representative. ACC/AHA Representative. Vascular and Endovascular Surgery Society Representative. Society for Cardiovascular Angiography and Interventions Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. Society for Vascular Medicine Representative. Society of Interventional Radiology Representative. Society for Clinical Vascular Surgery Representative. Society for Vascular Surgery Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Society for Vascular Nursing Representative
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Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, Fleisher LA, Fowkes FGR, Hamburg NM, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin JW, Patel RAG, Regensteiner JG, Schanzer A, Shishehbor MH, Stewart KJ, Treat-Jacobson D, Walsh ME. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2016; 69:1465-1508. [PMID: 27851991 DOI: 10.1016/j.jacc.2016.11.008] [Citation(s) in RCA: 411] [Impact Index Per Article: 51.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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15
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Nehler MR, McDermott MM, Treat-Jacobson D, Chetter I, Regensteiner JG. Functional outcomes and quality of life in peripheral arterial disease: current status. Vasc Med 2016; 8:115-26. [PMID: 14518614 DOI: 10.1191/1358863x03vm483ra] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This review examines current evidence for baseline functional impairment and changes with therapy in patients with peripheral arterial disease (PAD) - ranging from patients without claudication or critical limb ischemia (CLI) but other exertional leg symptoms (erroneously referred to as asymptomatic in the Fontaine classifi cation system), to patients with claudication and those with CLI. The review points out that the status of functional outcomes research is markedly different in focus and development in the different levels of disease severity - paradoxically less studied in the more severe CLI population than in patients with claudication, for example.
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Affiliation(s)
- Mark R Nehler
- Section of Vascular Surgery, Department of Surgery, University of Colorado Health Sciences Center, Denver, CO 80262-0312, USA.
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16
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Abstract
Patient-reported outcomes (PROs) after vascular surgery are becoming increasingly important in the current era of health care reform. Although a number of general quality of life instruments exist, vascular disease-specific instruments may provide more targeted data on how patients feel after specific interventions. Here we provide a review of both generic and disease-specific instruments focused on arterial conditions, including peripheral arterial disease, carotid arterial disease, and aortic disease, which have been described in the literature. While many different tools currently exist, there is a paucity of well-validated, specific instruments that accurately reflect functional and objective measures of patients' arterial disease burden. A full understanding of the existing tools available to assess patients' perceived lifestyle impact of their disease and its treatments is essential for both research and clinical purposes, and to highlight the need for additional work on this topic.
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Affiliation(s)
- Caitlin W Hicks
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Hospital, 600 N Wolfe Street, Halsted 668, Baltimore, MD 21287
| | - Ying Wei Lum
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Hospital, 600 N Wolfe Street, Halsted 668, Baltimore, MD 21287.
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17
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Murphy TP, Cutlip DE, Regensteiner JG, Mohler ER, Cohen DJ, Reynolds MR, Massaro JM, Lewis BA, Cerezo J, Oldenburg NC, Thum CC, Jaff MR, Comerota AJ, Steffes MW, Abrahamsen IH, Goldberg S, Hirsch AT. Supervised exercise, stent revascularization, or medical therapy for claudication due to aortoiliac peripheral artery disease: the CLEVER study. J Am Coll Cardiol 2015; 65:999-1009. [PMID: 25766947 PMCID: PMC5278564 DOI: 10.1016/j.jacc.2014.12.043] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 12/10/2014] [Accepted: 12/16/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Treatment for claudication that is due to aortoiliac peripheral artery disease (PAD) often relies on stent revascularization (ST). However, supervised exercise (SE) is known to provide comparable short-term (6-month) improvements in functional status and quality of life. Longer-term outcomes are not known. OBJECTIVES The goal of this study was to report the longer-term (18-month) efficacy of SE compared with ST and optimal medical care (OMC). METHODS Of 111 patients with aortoiliac PAD randomly assigned to receive OMC, OMC plus SE, or OMC plus ST, 79 completed the 18-month clinical and treadmill follow-up assessment. SE consisted of 6 months of SE and an additional year of telephone-based exercise counseling. Primary clinical outcomes included objective treadmill-based walking performance and subjective quality of life. RESULTS Peak walking time improved from baseline to 18 months for both SE (5.0 ± 5.4 min) and ST (3.2 ± 4.7 min) significantly more than for OMC (0.2 ± 2.1 min; p < 0.001 and p = 0.04, respectively). The difference between SE and ST was not significant (p = 0.16). Improvement in claudication onset time was greater for SE compared with OMC, but not for ST compared with OMC. Many disease-specific quality-of-life scales demonstrated durable improvements that were greater for ST compared with SE or OMC. CONCLUSIONS Both SE and ST had better 18-month outcomes than OMC. SE and ST provided comparable durable improvement in functional status and in quality of life up to 18 months. The durability of claudication exercise interventions merits its consideration as a primary PAD claudication treatment.
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Affiliation(s)
- Timothy P Murphy
- Department of Diagnostic Imaging, Vascular Disease Research Center, Rhode Island Hospital, Providence, Rhode Island.
| | - Donald E Cutlip
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Clinical Research Institute, Boston, Massachusetts
| | - Judith G Regensteiner
- University of Colorado School of Medicine-Aurora, Center for Women's Health Research, Aurora, Colorado
| | - Emile R Mohler
- Section of Vascular Medicine, Cardiovascular Division at Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J Cohen
- Division of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri
| | | | - Joseph M Massaro
- Harvard Clinical Research Institute, Boston, Massachusetts; Department of Biostatistics, Boston University, Boston, Massachusetts
| | - Beth A Lewis
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota
| | - Joselyn Cerezo
- Department of Diagnostic Imaging, Vascular Disease Research Center, Rhode Island Hospital, Providence, Rhode Island
| | - Niki C Oldenburg
- Lillehei Heart Institute, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Claudia C Thum
- Harvard Clinical Research Institute, Boston, Massachusetts
| | - Michael R Jaff
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Michael W Steffes
- Lillehei Heart Institute, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | | | - Alan T Hirsch
- Lillehei Heart Institute, Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota
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18
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Tripathi RK, Verma H. Commentary: endovascular therapy for intermittent claudication: is it time for re-evaluation? J Endovasc Ther 2014; 21:389-91. [PMID: 24915586 DOI: 10.1583/13-4618c.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Murphy TP, Reynolds MR, Cohen DJ, Regensteiner JG, Massaro JM, Cutlip DE, Mohler ER, Cerezo J, Oldenburg NC, Thum CC, Goldberg S, Hirsch AT. Correlation of patient-reported symptom outcomes and treadmill test outcomes after treatment for aortoiliac claudication. J Vasc Interv Radiol 2013; 24:1427-35; quiz 1436. [PMID: 23906799 PMCID: PMC4724411 DOI: 10.1016/j.jvir.2013.05.057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 05/20/2013] [Accepted: 05/21/2013] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To examine the relationship between objective treadmill test outcomes and subjective symptom outcomes among patients with claudication treated with stent revascularization (ST) compared with supervised exercise (SE). MATERIALS AND METHODS Five scales of the Peripheral Artery Questionnaire and Walking Impairment Questionnaire were correlated with peak walking time and treadmill claudication onset time. RESULTS The correlation between change in disease-specific quality of life (QOL) and change in peak walking time differed according to treatment group, with statistically significant correlations for all five scales for the ST group and weaker trends for the SE group, only one of which was statistically significant. In contrast, improvements in disease-specific QOL correlated well with increases in claudication onset time, with no significant interaction with treatment group for any of the five scales. CONCLUSIONS Disease-specific QOL results at 6 months in the Claudication: Exercise Vs. Endoluminal Revascularization (CLEVER) study show that improved maximal treadmill walking in patients with claudication treated with SE correlated poorly with self-reported symptom relief. Conversely, patients treated with ST showed good correlation between improved maximal treadmill walking and self-reported symptom improvement. The correlation between claudication onset time and self-reported symptom relief was good across treatment groups. This finding indicates that traditional objective treadmill test outcomes may not correlate well with symptom relief in patients with claudication. Future studies should investigate these data and improve understanding of patient relevance of traditional objective treadmill-based treatment outcomes.
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Affiliation(s)
- Timothy P Murphy
- Department of Diagnostic Imaging, Vascular Disease Research Center, Rhode Island Hospital, Gerry 337, 593 Eddy Street, Providence, RI 02903.
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20
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Abstract
Peripheral arterial disease (PAD) is a common vascular disease that reduces blood flow capacity to the legs of patients. PAD leads to exercise intolerance that can progress in severity to greatly limit mobility, and in advanced cases leads to frank ischemia with pain at rest. It is estimated that 12 to 15 million people in the United States are diagnosed with PAD, with a much larger population that is undiagnosed. The presence of PAD predicts a 50% to 1500% increase in morbidity and mortality, depending on severity. Treatment of patients with PAD is limited to modification of cardiovascular disease risk factors, pharmacological intervention, surgery, and exercise therapy. Extended exercise programs that involve walking approximately five times per week, at a significant intensity that requires frequent rest periods, are most significant. Preclinical studies and virtually all clinical trials demonstrate the benefits of exercise therapy, including improved walking tolerance, modified inflammatory/hemostatic markers, enhanced vasoresponsiveness, adaptations within the limb (angiogenesis, arteriogenesis, and mitochondrial synthesis) that enhance oxygen delivery and metabolic responses, potentially delayed progression of the disease, enhanced quality of life indices, and extended longevity. A synthesis is provided as to how these adaptations can develop in the context of our current state of knowledge and events known to be orchestrated by exercise. The benefits are so compelling that exercise prescription should be an essential option presented to patients with PAD in the absence of contraindications. Obviously, selecting for a lifestyle pattern that includes enhanced physical activity prior to the advance of PAD limitations is the most desirable and beneficial.
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Affiliation(s)
- Tara L Haas
- Angiogenesis Research Group, Muscle Health Research Centre, Faculty of Health, York University, Toronto, Ontario, Canada
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21
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Skeletal Muscle Adaptation in Response to Supervised Exercise Training for Intermittent Claudication. Eur J Vasc Endovasc Surg 2012; 44:313-7. [DOI: 10.1016/j.ejvs.2012.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 07/02/2012] [Indexed: 11/18/2022]
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22
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Beckitt TA, Day J, Morgan M, Lamont PM. Calf muscle oxygen saturation and the effects of supervised exercise training for intermittent claudication. J Vasc Surg 2012; 56:470-5. [DOI: 10.1016/j.jvs.2011.11.140] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 11/10/2011] [Accepted: 11/29/2011] [Indexed: 10/28/2022]
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23
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Hirsch AT, Allison MA, Gomes AS, Corriere MA, Duval S, Ershow AG, Hiatt WR, Karas RH, Lovell MB, McDermott MM, Mendes DM, Nussmeier NA, Treat-Jacobson D. A Call to Action: Women and Peripheral Artery Disease. Circulation 2012; 125:1449-72. [DOI: 10.1161/cir.0b013e31824c39ba] [Citation(s) in RCA: 232] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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A meta-analysis of the outcome of endovascular and noninvasive therapies in the treatment of intermittent claudication. J Vasc Surg 2011; 54:1511-21. [DOI: 10.1016/j.jvs.2011.06.106] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 06/13/2011] [Accepted: 06/19/2011] [Indexed: 11/22/2022]
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Mazari FAK, Khan JA, Carradice D, Samuel N, Abdul Rahman MNA, Gulati S, Lee HLD, Mehta TA, McCollum PT, Chetter IC. Randomized clinical trial of percutaneous transluminal angioplasty, supervised exercise and combined treatment for intermittent claudication due to femoropopliteal arterial disease. Br J Surg 2011; 99:39-48. [DOI: 10.1002/bjs.7710] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2011] [Indexed: 11/10/2022]
Abstract
Abstract
Background
The aim was to compare percutaneous transluminal angioplasty (PTA), a supervised exercise programme (SEP) and combined treatment (PTA plus SEP) for intermittent claudication due to femoropopliteal arterial disease.
Methods
Consenting patients with femoropopliteal arterial lesions were randomized to one of three treatment arms: PTA, SEP, or PTA plus SEP. All patients received optimal medical treatment. Patients were assessed at baseline and 1, 3, 6 and 12 months after intervention. Clinical (ankle pressures, walking distances, symptoms) and quality-of-life (QoL) outcomes (Short Form 36, VascuQol) were analysed.
Results
A total of 178 patients (108 men, median age 70 years) were included. All three treatment groups demonstrated significant clinical and QoL improvements. One year after PTA (60 patients, 8 withdrew), 37 patients (71 per cent) had improved (16 mild, 16 moderate, 5 marked), nine (17 per cent) showed no improvement and six (12 per cent) had deteriorated. After SEP (60 patients, 14 withdrew), 32 patients (70 per cent) had improved (19 mild, 10 moderate, 3 marked), six (13 per cent) showed no improvement and eight (17 per cent) had deteriorated. After PTA plus SEP (58 patients, 11 withdrew), 40 patients (85 per cent) had improved (18 mild, 20 moderate, 2 marked), seven (15 per cent) showed no improvement and none had deteriorated. On intergroup analysis, PTA and SEP alone were equally effective in improving clinical outcomes, although the effect was short-lived. PTA plus SEP produced a more sustained clinical improvement, but there was no significant QoL advantage.
Conclusion
For patients with intermittent claudication due to femoropopliteal disease, PTA, SEP, and PTA plus SEP were all equally effective in improving walking distance and QoL after 12 months. Registration number: NCT00798850 (http://www.clinicaltrials.gov). Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- F A K Mazari
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - J A Khan
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - D Carradice
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - N Samuel
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | | | - S Gulati
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - H L D Lee
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - T A Mehta
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - P T McCollum
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
| | - I C Chetter
- Academic Vascular Surgical Unit, University of Hull, Hull, UK
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Frans FA, Bipat S, Reekers JA, Legemate DA, Koelemay MJW. Systematic review of exercise training or percutaneous transluminal angioplasty for intermittent claudication. Br J Surg 2011; 99:16-28. [DOI: 10.1002/bjs.7656] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2011] [Indexed: 11/08/2022]
Abstract
Abstract
Background
The aim was to summarize the results of all randomized clinical trials (RCTs) comparing percutaneous transluminal angioplasty (PTA) with (supervised) exercise therapy ((S)ET) in patients with intermittent claudication (IC) to obtain the best estimates of their relative effectiveness.
Methods
A systematic review was performed of relevant RCTs identified from the MEDLINE, Embase and Cochrane Library databases. Eligible RCTs compared PTA with (S)ET, included patients with IC due to suspected or known aortoiliac and/or femoropopliteal artery disease, and compared their effectiveness in terms of functional outcome and/or quality of life (QoL).
Results
Eleven of 258 articles identified (reporting data on eight randomized clinical trials) met the inclusion criteria. One trial included patients with isolated aortoiliac artery obstruction, three trials studied those with femoropopliteal artery obstruction and five included those with combined lesions. Two trials compared PTA with advice on ET, four PTA with SET, two PTA plus SET with SET and two PTA plus SET with PTA. Although the endpoints in most trials comprised walking distances and QoL, pooling of data was impossible owing to heterogeneity. Generally, the effectiveness of PTA and (S)ET was equivalent, although PTA plus (S)ET improved walking distance and some domains of QoL scales compared with (S)ET or PTA alone.
Conclusion
As IC is a common healthcare problem, defining the optimal treatment strategy is important. A combination of PTA and exercise (SET or ET advice) may be superior to exercise or PTA alone, but this needs to be confirmed. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- F A Frans
- Department of Radiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Vascular Surgery, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - S Bipat
- Department of Radiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J A Reekers
- Department of Radiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - D A Legemate
- Department of Vascular Surgery, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M J W Koelemay
- Department of Vascular Surgery, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Prevalence and Predictors of Persistent Health Status Impairment in Patients Referred to a Vascular Clinic with Intermittent Claudication. Eur J Vasc Endovasc Surg 2011; 42:355-62. [DOI: 10.1016/j.ejvs.2011.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 02/07/2011] [Indexed: 11/20/2022]
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Mays RJ, Casserly IP, Kohrt WM, Ho PM, Hiatt WR, Nehler MR, Regensteiner JG. Assessment of functional status and quality of life in claudication. J Vasc Surg 2011; 53:1410-21. [PMID: 21334172 DOI: 10.1016/j.jvs.2010.11.092] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 11/05/2010] [Accepted: 11/08/2010] [Indexed: 12/27/2022]
Abstract
BACKGROUND Treadmill walking is commonly used to evaluate walking impairment and efficacy of treatment for intermittent claudication (IC) in clinical and research settings. Although this is an important measure, it does not provide information about how patients perceive the effects of their treatments on more global measures of health-related quality of life (HRQOL). METHODS PubMed/Medline was searched to find publications about the most commonly used questionnaires to assess functional status and/or general and disease-specific HRQOL in patients with peripheral artery disease (PAD) who experience IC. Inclusion criteria for questionnaires were based on existence of a body of literature in symptomatic PAD. RESULTS Six general questionnaires and seven disease-specific questionnaires are included, with details about the number of domains covered and how each tool is scored. The Medical Outcomes Study Short Form 36-item questionnaire and Walking Impairment Questionnaire are currently the most used general and disease-specific questionnaires at baseline and after treatment for IC, respectively. CONCLUSIONS The use of tools that assess functional status and HRQOL has importance in both the clinical and research areas to assess treatment efficacy from the patient's perspective. Therefore, assessing HRQOL in addition to treadmill-measured walking ability provides insight as to the effects of treatments on patient outcomes and may help guide therapy.
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Affiliation(s)
- Ryan J Mays
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
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29
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Wilson SE. Trials of Endovascular Treatment for Superficial Femoral Artery Occlusive Lesions: A Call for Medically Managed Control Patients. Ann Vasc Surg 2010; 24:498-502. [DOI: 10.1016/j.avsg.2009.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Revised: 08/07/2009] [Accepted: 08/27/2009] [Indexed: 10/20/2022]
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Abstract
BACKGROUND Endovascular stents have been suggested as a means to improve the patency of arteries after angioplasty in patients with intermittent claudication. This is an update of a Cochrane review published in 2002. OBJECTIVES The null hypothesis to be tested by this review is that for individuals with claudication the use of an endovascular stent, in addition to percutaneous transluminal angioplasty, does not improve symptoms of life-style limiting claudication when compared to percutaneous angioplasty alone. SEARCH STRATEGY For this update the Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last searched August 2009) and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (last searched 2009, Issue 3). SELECTION CRITERIA Randomised trials comparing angioplasty alone versus angioplasty with endovascular stents in patients with intermittent claudication. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted the data. Only published trial data were used but unpublished data were sought for the update. Effectiveness was measured by the pre-defined primary outcome measures restenosis or reocclusion rates and maximum walking distance. MAIN RESULTS Two studies were included involving a total of 104 participants. Both studies included only individuals with femoro-popliteal disease. They compared angioplasty and stenting with the Palmaz stent against angioplasty alone. Although one study showed a slight statistical advantage in arterial patency after angioplasty alone, this was not found when the two studies were combined. No differences in the secondary outcomes were detected in either study. AUTHORS' CONCLUSIONS The small number of relevant studies identified together with the small sample sizes and methodological weaknesses severely limit the usefulness of this review in guiding practice. The results from larger multicentre trials are needed.
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Affiliation(s)
- Paul Bachoo
- Aberdeen Royal infirmaryWard 36, Vascular SurgeryForesterhillAberdeenScotlandUK
| | - P A Thorpe
- Aberdeen Royal InfirmaryDepartment of RadiologyForesterhillAberdeenUKAB25 2ZA
| | - Heather Maxwell
- University of EdinburghPublic Health SciencesTeviot PlaceEdinburghUKEH8 9AG
| | - Karen Welch
- University of EdinburghPublic Health SciencesTeviot PlaceEdinburghUKEH8 9AG
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Arthurs ZM, Bishop PD, Feiten LE, Eagleton MJ, Clair DG, Kashyap VS. Evaluation of peripheral atherosclerosis: a comparative analysis of angiography and intravascular ultrasound imaging. J Vasc Surg 2010; 51:933-8; discussion 939. [PMID: 20080002 DOI: 10.1016/j.jvs.2009.11.034] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 10/26/2009] [Accepted: 11/01/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Angiography remains a critical component for diagnostic imaging and therapeutic intervention in peripheral arterial disease (PAD). The goal of this study was to compare angiography with corresponding intravascular ultrasound (IVUS) imaging of the same vessels in patients with PAD. METHODS From 2004 to 2008, 93 patients undergoing angiography for PAD were recruited in a prospective observational analysis. At the time of angiography, diseased lower extremities were interrogated using a 10-cm IVUS pullback with registration points. IVUS data were analyzed with radiofrequency techniques for vessel and lumen diameter, plaque volume, plaque composition, and cross-sectional area. Similarly, three vascular surgeons blinded to the IVUS data graded corresponding angiographic images according to vessel diameter, degree of stenosis, degree of calcification, and extent of eccentricity. Statistical analyses of matched IVUS images and angiograms were performed. RESULTS The distribution of demographic and risk variables were typical for PAD: 54% male, 96% hypertension, 78% hyperlipidemia, 44% diabetic, 87% tobacco history, 65% coronary artery disease, and 10% end-stage renal disease. Symptoms precipitating the angiographic evaluation included claudication (53%), rest pain (18%), and tissue loss (29%). Angiographic and IVUS interpretation were similar for luminal diameters, but external vessel diameter was greater by IVUS imaging (7.0 +/- 0.7 vs 5.2 +/- 0.8 mm, P < .05). The two-dimensional diameter method resulted in a significant correlation for stenosis determination (r = 0.84); however, IVUS determination of vessel area stenosis was greater by 10% (95% confidence interval, 0.3%-21%, P < .05). IVUS imaging indicated that a higher proportion of plaques were concentric. Grading of calcification was moderate to severe in 40% by angiography but in only 7% by IVUS (P < .05). CONCLUSIONS In the evaluation of PAD, angiography and IVUS imaging provide similar luminal diameters and diameter-reducing stenosis measurements. Determination of overall vessel diameter and interpretation of plaque morphology by angiography are discordant from IVUS-derived data.
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Affiliation(s)
- Zachary M Arthurs
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Early Outcomes From a Randomized, Controlled Trial of Supervised Exercise, Angioplasty, and Combined Therapy in Intermittent Claudication. Ann Vasc Surg 2010; 24:69-79. [DOI: 10.1016/j.avsg.2009.07.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Revised: 06/24/2009] [Accepted: 07/13/2009] [Indexed: 11/20/2022]
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Abstract
With the proliferation of devices and techniques for lower extremity endovascular revascularization, treatment decisions become increasingly difficult as only limited experience with these new technologies is available for review. This monograph attempts to define the current state of the literature available to guide endovascular treatment of superficial artery disease, and to provide a baseline for future studies.
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Affiliation(s)
- George H Meier
- University of Cincinnati College of Medicine, Vascular Division, Cincinnati, Ohio 45267, USA.
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Spronk S, Bosch JL, den Hoed PT, Veen HF, Pattynama PMT, Hunink MGM. Intermittent Claudication: Clinical Effectiveness of Endovascular Revascularization versus Supervised Hospital-based Exercise Training—Randomized Controlled Trial. Radiology 2009; 250:586-95. [DOI: 10.1148/radiol.2501080607] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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The Adjuvant Benefit of Angioplasty in Patients with Mild to Moderate Intermittent Claudication (MIMIC) Managed by Supervised Exercise, Smoking Cessation Advice and Best Medical Therapy: Results from Two Randomised Trials for Stenotic Femoropopliteal and Aortoiliac Arterial Disease. Eur J Vasc Endovasc Surg 2008; 36:680-8. [DOI: 10.1016/j.ejvs.2008.10.007] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Accepted: 10/14/2008] [Indexed: 11/26/2022]
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Keeling AN, Naughton PA, O'Connell A, Lee MJ. Does percutaneous transluminal angioplasty improve quality of life? J Vasc Interv Radiol 2008; 19:169-76. [PMID: 18341944 DOI: 10.1016/j.jvir.2007.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Revised: 07/18/2007] [Accepted: 09/17/2007] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To prospectively assess the impact of peripheral percutaneous transluminal angioplasty (PTA) on quality of life (QOL) in patients with intermittent claudication or critical limb ischemia (CLI). The secondary purpose was to determine if periprocedural medication altered patient QOL. MATERIALS AND METHODS A total of 72 patients underwent lower-limb PTA (86 lesions) over a period of 12 months. QOL data were obtained before PTA and at 1 and 6 months after PTA with use of the Short Form-36 (SF-36) questionnaire. RESULTS The SF-36 questionnaire was completed in 100% of cases before PTA, in 89% at 1 month after PTA, and in 78% at 6 months after PTA. Baseline QOL was worse than the QOL quoted for the normal population. Overall, there was an improvement in QOL in seven of the nine health domains at 1 month after PTA, and the improvements were significant (P < .01) in five. Improvement was demonstrated at 6 months in all nine QOL domains measured, which was significant (P < .01) in five. Patients with intermittent claudication (n = 40) exhibited an improvement in all nine health domains at 6 months, which was significant (P < .05) in seven. The CLI group (n = 32) showed an improvement in five domains at 6 months, which was significant (P < .05) in two. Subjects with intermittent claudication experienced a more significant improvement than those with CLI. SF-36 pain scores at 1 month after PTA were significantly better in patients taking aspirin than in those who were not (P < .001). CONCLUSIONS PTA results in improved QOL in patients with intermittent claudication and CLI as early as 1 month, which was shown to be maintained at 6 months in our small series. Aspirin significantly improves pain after PTA. QOL assessment is useful after peripheral angioplasty.
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Affiliation(s)
- Aoife N Keeling
- Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
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Virkkunen J, Venermo M, Saarinen J, Keski-Nisula L, Apuli P, Kankainen AL, Salenius J. Impact of Endovascular Treatment on Clinical Status and Health-Related Quality of Life. Scand J Surg 2008; 97:50-5. [DOI: 10.1177/145749690809700107] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and Aims: Investigating the impact of percutaneous transluminal angioplasty (PTA) on clinical status and health related quality of life in patients with claudication and critical limb ischaemia (CLI). Material and Methods: 61 patients and 64 limbs underwent a primary PTA (30 claudication and 34 CLI cases). Clinical status was graded according to Ahn and Rutherford and ankle/brachial index (ABI). Quality of life was assessed using the Nottingham Health Profile (NHP) preoperatively, one month and one year after the procedure. Triplex scan evaluation of the treated arterial segment was carried out postoperatively and one year after the procedure. Results: Claudication: 24/27 patients underwent one-year follow up, after which 20/24 had no claudication. In triplex evaluation 17 (63.0%) treated segments were open with 0–50% restenosis, 9 (33.3%) with 51–99% restenosis and one (3.7%) was occluded. CLI: 13/34 (38.2%) patients underwent one-year follow-up after which eight patients (61.5%) were asymptomatic and five (38.1%) had claudication. In triplex evaluation there was 0–50% restenosis in 6 (46.2%) segments treated with PTA and 51–99% restenosis in 7 (53.8%) segments. 21 (61.8%) patients did not conclude the one year follow up: 7 had died, 5 had undergone bypass surgery and 6 an amputation and 3 did not attend the follow-up up for unknown reasons. Quality of life: For CLI patients, improvement was observed in the domain of pain, which continued throughout the follow-up period. Among the claudicants, the domain of physical mobility was improved at one month's follow-up, but this effect disappeared during the following year and could not be seen at one the one- year follow-up. Conclusions: Technical success and one-year results in claudication are good, and the rate of complications is low. However, although PTA resulted in an immediate improvement in the quality of life, this effect was not seen in the long term. In critical limb ischemia there was a group of patients in whom PTA led to a significant benefit in terms of limb salvage and quality of life.
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Affiliation(s)
- J. Virkkunen
- Department of Thoracic and Vascular Surgery, Central Hospital of Central Finland, Jyväskylä, Finland
| | - M. Venermo
- Department of Vascular Surgery, Tampere University Hospital, Tampere, Finland
| | - J. Saarinen
- Department of Vascular Surgery, Tampere University Hospital, Tampere, Finland
| | - L. Keski-Nisula
- Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - P. Apuli
- Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - A.-L. Kankainen
- Department of Mathematics and Statistics, University of Jyväskylä, Jyväskylä, Finland
| | - J. Salenius
- Department of Vascular Surgery, Tampere University Hospital, Tampere, Finland
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Abstract
Exercise advice is a well established component of the conservative management of intermittent claudication. Supervised programmes of exercise remain relatively uncommon and are provided mainly in secondary care. This review outlines the evidence for the effectiveness of different exercise regimens and the relative benefits of exercise therapy, where comparisons have been made with medical therapy, angioplasty and surgery.
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Affiliation(s)
- A H R Stewart
- Department of Vascular Surgery, Bristol Royal Infirmary.
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Abstract
Improvement in quality of life is the ultimate goal of healthcare for the treatment of intermittent claudication. Until recently, the measures of success after therapy were those derived from the vascular laboratory, including ankle-brachial indices and ankle and toe pressures. There are now several validated and reliable survey tools that can assess patient-reported quality of life in a generic or disease-specific manner. Major survey instruments are reviewed. The information gathered through these quality-of-life assessment tools is important to all those involved in the care of patients with peripheral arterial disease. Although claudication is neither life- nor limb-threatening, it has a significant negative impact on quality of life, as measured by these instruments. Patients so afflicted report more bodily pain, worse physical function, and worse perceived health, in addition to limited walking ability. These measures of quality of life do not correlate with standard parameters of ankle-brachial index or ankle pressures. Treatment of the claudicant with exercise therapy and percutaneous or open revascularization also impacts quality of life. Each of these modalities is capable of improving quality of life, but some are associated with decline over time. The major benefits and risks to quality of life of these specific forms of treatment for the claudicant are reviewed. This data demonstrates that patients suffering from symptoms of intermittent claudication are best served by therapies that address their major self-reported impediments to quality of life.
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Affiliation(s)
- Sandra Spronk
- Vascular Laboratory, Ikazia Hospital, Rotterdam, The Netherlands, and Department of Surgery, University of Illinois College of Medicine, Chicago, USA.
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Safley DM, House JA, Laster SB, Daniel WC, Spertus JA, Marso SP. Quantifying improvement in symptoms, functioning, and quality of life after peripheral endovascular revascularization. Circulation 2007; 115:569-75. [PMID: 17242281 DOI: 10.1161/circulationaha.106.643346] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with peripheral arterial disease often undergo peripheral endovascular revascularization (PER) to alleviate symptoms. Despite the growth of PER, little information exists quantifying the health status benefits after the procedure. METHODS AND RESULTS From February 2001 to August 2004, 477 consecutive patients underwent PER for symptomatic peripheral arterial disease. Of these, 300 consented to participate in a longitudinal follow-up study of their health status. Health status was quantified with the disease-specific Peripheral Artery Questionnaire and the generic Short Form-12 and the EuroQol 5 Dimensions (EQ5D)questionnaire. Scores range from 0 to 100; higher scores represent fewer symptoms and better health status. The average age of the cohort was 68+/-11 years (mean+/-SD); 186 (62%) were male, 288 (96%) were white, and 118 (39%) were diabetic. Clinical follow-up was attained in 99% of patients; health status assessments were made in 86%. Mean Peripheral Artery Questionnaire summary scores improved significantly after revascularization from 31+/-19 to 62+/-27 at 1 year (P<0.0001). Generic health status scores also improved significantly (P<0.001 for all). Despite a technically successful procedure in 98% of patients, 21% of patients did not achieve the minimal clinically important improvement of an 8-point change in Peripheral Artery Questionnaire Summary score after PER (35+/-19 at baseline versus 31+/-16 at 1 year; P=0.09). CONCLUSIONS For most patients, significant and sustained improvements in symptoms, functioning, and quality of life occur after PER. Identifying and counseling patients less likely to benefit from PER is an important future research direction.
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Affiliation(s)
- David M Safley
- Mid America Heart Institute, St Luke's Hospital, Kansas City, MO 64111, USA
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Rocha-Singh KJ, Jaff MR, Crabtree TR, Bloch DA, Ansel G. Performance goals and endpoint assessments for clinical trials of femoropopliteal bare nitinol stents in patients with symptomatic peripheral arterial disease. Catheter Cardiovasc Interv 2007; 69:910-9. [PMID: 17377972 DOI: 10.1002/ccd.21104] [Citation(s) in RCA: 183] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This analysis proposes safety and performance goals for prospective single-arm trials of bare nitinol stents to treat patients with debilitating claudication associated with femoropopliteal (FP) atherosclerotic lesions. BACKGROUND To date there have been no analyses of clinical trials data to set efficacy and safety benchmarks for new bare nitinol stents in the treatment of claudication from FP disease. Industry has been reluctant to sponsor studies of nitinol stents due to logistical barriers. METHODS VIVA Physician's, Inc. (VPI) analyzed subject-level data from the PTA control arm of three randomized FDA device trials conducted by industry. Subjects with Rutherford category 2-4 claudication and FP lesion lengths 4-15 cm with 12 month duplex ultrasound (DUS) assessment were identified. These data were combined with the results of a survey of the medical literature (1990-2006) for similar subjects. RESULTS Analysis of the industry derived control arm PTA data identified 116 patients (mean lesion length 8.7 cm) with a 12 month DUS defined FP patency of 28%. A similar cohort of 191 patients was identified from the medical literature in which the 12-month vessel patency equaled 37%; from these combined patient cohorts, expected vessel patency for PTA was estimated to equal 33%. CONCLUSION Based on the PTA performance efficacy rate of 33% derived from industry clinical trial data and the medical literature, and the requirement that the bare nitinol stent 12-month efficacy performance goal be set to equal twice this rate, the patency efficacy goal equals 66%. Additional information is provided on safety and other reporting standards and stent integrity evaluation for bare metal stents.
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Nylaende M, Abdelnoor M, Stranden E, Morken B, Sandbaek G, Risum Ø, Jørgensen JJ, Lindahl AK, Arnesen H, Seljeflot I, Kroese AJ. The Oslo Balloon Angioplasty versus Conservative Treatment Study (OBACT)—The 2-years Results of a Single Centre, Prospective, Randomised Study in Patients with Intermittent Claudication. Eur J Vasc Endovasc Surg 2007; 33:3-12. [PMID: 17055756 DOI: 10.1016/j.ejvs.2006.08.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Accepted: 08/27/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare the effect of optimal medical treatment only (OMT) with OMT combined with percutaneous transluminal angioplasty (OMT+PTA) in patients with intermittent claudication (IC). DESIGN A single centre prospective, randomised study. Quality of life (QoL) was the primary outcome measure. Secondary measures were ankle-brachial-index (ABI), treadmill walking distances and mortality. METHODS From a total of 434 patients considered for inclusion into the trial, only 56 patients with disabling IC fulfilled the inclusion criteria. The patients were randomised into treatment groups consisting of 28 patients each and followed for 2 years. ABI and treadmill walking distances were measured in addition to the visual analogue scale (VAS) for pain evaluation, and QoL assessment using the Short Form (SF-36 and Claudication Scale (CLAU-S). RESULTS The demographic data in the 2 groups were almost identical. After 2 years of follow-up the ABI, the treadmill walking distances and the VAS were significant improved in the group treated with OMT+PTA, compared to the group treated with OMT only (p<0.01 for all). Furthermore, some variables from the QoL assessment also showed a significant improvement in favour of the OMT+PTA group (p<0.05 for all). CONCLUSION The advantage of conducting a single centre study and adhering to very strict inclusion criteria was illustrated by the homogenous demographic data of the two groups. This partly outweighed the disadvantage of having included a relatively small number of patients. Early intervention with PTA in addition to OMT seems to have a generally more positive effect compared to OMT only, on haemodynamic, functional as well as QoL aspects during the first 2 years in patients with IC.
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Affiliation(s)
- M Nylaende
- Department of Vascular Surgery, Aker University Hospital, Norway.
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Kalbaugh CA, Taylor SM, Blackhurst DW, Dellinger MB, Trent EA, Youkey JR. One-year prospective quality-of-life outcomes in patients treated with angioplasty for symptomatic peripheral arterial disease. J Vasc Surg 2006; 44:296-302; discussion 302-3. [PMID: 16814976 DOI: 10.1016/j.jvs.2006.04.045] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Accepted: 04/22/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Despite lower reported patency rates than open bypass, percutaneous transluminal angioplasty (PTA) may result in symptom relief, limb salvage, maintenance of ambulation and independent living, and overall improved quality of life. The goal of this study was to prospectively assess quality of life and functional outcomes after angioplasty and stenting in patients with chronic leg ischemia. METHODS From August to December 2002, 84 patients with 118 chronically ischemic limbs underwent PTA with or without stenting as part of an ongoing prospective project performed to examine management of symptomatic peripheral arterial disease. All patients completed a preprocedure health questionnaire (Short Form 36) to provide adequate baseline data. Each patient was followed up every 3 months after treatment for 1 year to determine traditional outcomes of arterial patency, limb salvage, survival and amputation-free survival, and functional outcomes assessed according to improvement in quality of life, maintenance of ambulatory status, and maintenance of independent living status. The entire cohort was analyzed, as were subgroups of patients with lifestyle-limiting claudication and those with critical limb ischemia. Outcomes were analyzed by using Kaplan-Meier life-table analysis, the log-rank test for survival curves, and the one-sample t test. A Cox proportional hazard model was used to determine whether presentation and level of disease were independent predictors of outcome. RESULTS Of the 84 patients, 54 (64.3%) were treated for claudication (34 aortoiliac occlusive disease and 20 infrainguinal disease), and 30 (35.7%) were treated for critical limb ischemia (11 aortoiliac occlusive disease and 19 infrainguinal disease). One-year results for the 54 patients with claudication were as follows: primary patency, 78.5%; limb salvage, 100%; amputation-free survival, 96.3%; survival, 96.3%; maintenance of ambulation status, 100%; and maintenance of independence, 100%. There was statistical improvement in all physical function categories, including physical function (29.4 +/- 8.9 vs 37.1 +/- 11.3; P < .0001), role-physical (32.5 +/- 11.3 vs 39.5 +/- 13.0; P = .0001), bodily pain (35.8 +/- 8.5 vs 42.9 +/- 10.9; P < .0001), and aggregate physical scoring (31.1 +/- 9.7 vs 38.1 +/- 11.5; P < .0001). One-year results for the 30 patients with critical limb ischemia were as follows: primary patency, 35.2%; limb salvage, 77.2%; amputation-free survival, 50.0%; survival, 60.0%; maintenance of ambulation status, 75.8%; and maintenance of independence, 92.8%. There was statistical improvement in bodily pain resolution (35.3 +/- 12.0 vs 46.6 +/- 12.0; P = .0009). Cox models with hazard ratios (HRs) revealed that presentation was a significant predictor for outcomes of primary patency (HR, 4.2; P= .0002), secondary patency (HR, 6.0; P < .0001), limb salvage (HR, 20.2; P = .0047), survival (HR, 10.9; P = .0002), and amputation-free survival (HR, 11.2; P < .0001). Conversely, the level of disease was predictive of outcome only for primary patency (HR, 1.8; P = .00289). CONCLUSIONS Despite inferior reconstruction patency rates when compared with the historical results of open bypass, PTA provides excellent functional outcomes with good patient satisfaction, especially for treating claudication. These findings support a more liberal use of PTA intervention for patients with vasculogenic claudication.
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Affiliation(s)
- Corey A Kalbaugh
- Academic Department of Surgery, Greenville Hospital System, Greenville, SC 29605, USA.
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Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B. ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): A Collaborative Report from the American Association for Vascular Surgery/Society for Vascular Surgery,⁎Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease). J Am Coll Cardiol 2006. [DOI: 10.1016/j.jacc.2006.02.024] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Klein WM, van der Graaf Y, Seegers J, Spithoven JH, Buskens E, van Baal JG, Buth J, Moll FL, Overtoom TTC, van Sambeek MRHM, Mali WPTM. Dutch Iliac Stent Trial: Long-term Results in Patients Randomized for Primary or Selective Stent Placement. Radiology 2006; 238:734-44. [PMID: 16371580 DOI: 10.1148/radiol.2382041053] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine long-term results of the prospective Dutch Iliac Stent Trial. MATERIALS AND METHODS The study protocol was approved by local institutional review boards. All patients gave written informed consent. Two hundred seventy-nine patients (201 men, 78 women; mean age, 58 years) with iliac artery disease were randomly assigned to undergo primary stent placement (143 patients) or percutaneous transluminal angioplasty (PTA) with selective stent placement in cases in which the residual mean pressure gradient was greater than 10 mm Hg across the treated site (136 patients). Before and at 3, 12, and 24 months and 5-8 years after treatment, all patients underwent assessment, which included duplex ultrasonography (US), ankle-brachial index (ABI) measurement, Fontaine classification of symptoms, and completion of the Rand 36-Item Health survey for quality-of-life assessment. Treatment was considered successful for symptoms if symptoms increased at least one Fontaine grade, for ABI if ABI increased more than 0.10, for patency if peak systolic velocity ratio at duplex US was less than 2.5, and for quality of life if the RAND 36-Item Health Survey score increased more than 15 points. Effects of both treatments on symptoms, quality of life, patency, and ABI were compared by using survival analyses. RESULTS Patients who underwent PTA and selective stent placement had better improvement of symptoms (hazard ratio [HR], 0.8; 95% confidence limits [CLs]: 0.6, 1.0) than did patients treated with primary stent placement, whereas ABI (HR, 0.9; 95% CLs: 0.7, 1.3), iliac patency (HR, 1.3; 95% CLs: 0.8, 2.1), and score for quality of life for nine survey dimensions did not support a difference between treatment groups. CONCLUSION Patients treated with PTA and selective stent placement in the iliac artery had a better outcome for symptomatic success compared with patients treated with primary stent placement, whereas data about iliac patency, ABI, and quality of life did not support a difference between groups.
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Affiliation(s)
- Willemijn M Klein
- Department of Radiology and Julius Center of Health Sciences and Primary Care, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Killewich LA. Improving Functional Status and Quality of Life in Elderly Patients with Peripheral Arterial Disease. J Am Coll Surg 2006; 202:345-55. [PMID: 16427563 DOI: 10.1016/j.jamcollsurg.2005.09.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2005] [Revised: 09/26/2005] [Accepted: 09/28/2005] [Indexed: 10/25/2022]
Affiliation(s)
- Lois A Killewich
- Section of Vascular Surgery, Department of Surgery, The University of Texas Medical Branch, Galveston, TX 77555, USA
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47
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Catheter-Based Intervention. Vasc Med 2006. [DOI: 10.1016/b978-0-7216-0284-4.50025-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abdul Raouf A, Rouleau Y, Clement A, Le Roux P, Genay P, Ricco JB. Endoluminal Angioplasty of the Popliteal Artery. Review of 54 Consecutive Patients. Eur J Vasc Endovasc Surg 2005; 30:610-3. [PMID: 16054849 DOI: 10.1016/j.ejvs.2005.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Revised: 06/10/2005] [Accepted: 06/27/2005] [Indexed: 10/25/2022]
Abstract
AIM To determine the results of endoluminal angioplasty for occlusive or stenotic lesions of the popliteal artery. METHODS Retrospective study of symptomatic patients having popliteal occlusive lesions treated by endoluminal balloon angioplasty. All patients underwent systematic preoperative and postoperative color duplex scan and preoperative angiography. The principal endpoints were primary and primary assisted patency. RESULTS Fifty-four percutaneous endoluminal angioplasties of the popliteal artery, including six procedures with stents, were performed in 50 patients. In all cases, the superficial femoral artery was patent and without significant stenosis. Primary patency for the entire cohort was 57.4+/-6.7% at 1 and 2 years. Primary assisted patency was 86.3+/-4.8% at 1 year, and 79.1+/-5.9% at 2 years. The results of angioplasty appeared to be better in patients with intermittent claudication when compared to patients with critical limb ischaemia, (p=0.0006). Angioplasty of single occlusive lesions had a better prognosis than that of multiple occlusive lesions (p=0.01). Results of angioplasty were better at the below-knee and median popliteal artery than at the femoro-popliteal junction or in the above-knee popliteal artery (p=0.03). Tibial run-off and isolated popliteal stenosis versus isolated popliteal thrombosis did not seem to affect primary patency rate. CONCLUSION Results of angioplasty of the popliteal artery are acceptable for claudicants, especially those with TASC-A lesions and those with lesions in the distal two thirds of the popliteal artery.
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Affiliation(s)
- A Abdul Raouf
- Service of Vascular Surgery, CHD Les Ouclairies, 85925 La Roche sur Yon, France.
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Davies MG, Waldman DL, Pearson TA. Comprehensive Endovascular Therapy for Femoropopliteal Arterial Atherosclerotic Occlusive Disease. J Am Coll Surg 2005; 201:275-96. [PMID: 16038827 DOI: 10.1016/j.jamcollsurg.2005.03.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Revised: 03/07/2005] [Accepted: 03/07/2005] [Indexed: 11/22/2022]
Affiliation(s)
- Mark G Davies
- Center for Vascular Disease, Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA.
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Kakkos SK, Geroulakos G, Nicolaides AN. Improvement of the Walking Ability in Intermittent Claudication due to Superficial Femoral Artery Occlusion with Supervised Exercise and Pneumatic Foot and Calf Compression: A Randomised Controlled Trial. Eur J Vasc Endovasc Surg 2005; 30:164-75. [PMID: 15890545 DOI: 10.1016/j.ejvs.2005.03.011] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2004] [Accepted: 03/03/2005] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To compare the effect of unsupervised exercise, supervised exercise and intermittent pneumatic foot and calf compression (IPC) on the claudication distance, lower limb arterial haemodynamics and quality of life of patients with intermittent claudication. METHODS Thirty-four eligible patients with stable intermittent claudication were randomised to IPC (n = 13, 3h/d for 6 months), supervised exercise (n = 12, three hourly sessions/week for 6 months) or unsupervised exercise (n = 9). In each patient, initial claudication distance (ICD), absolute claudication distance (ACD), resting ankle brachial pressure index (ABPI), and resting hyperaemic calf arterial inflow were measured before, 6 weeks, 6 months and 1 year after randomisation. Quality of life was assessed with the short form (SF)-36, walking impairment (WIQ) and intermittent claudication questionnaires (ICQ). RESULTS Compared with unsupervised exercise, both IPC and supervised exercise, increased ICD and ACD, up to 2.83 times. IPC increased arterial inflow (p < 0.05 at 6 weeks) and ABPI. Supervised exercise decreased arterial inflow and increased ABPI (p < 0.05 at 6 months). Unsupervised exercise had no effect on arterial inflow or ABPI. IPC improved significantly the ICQ score and the speed score of the WIQ, while supervised exercise improved the WIQ claudication severity score. At 1 year clinical effectiveness of supervised exercise and IPC was largely preserved. CONCLUSIONS IPC, by augmenting leg perfusion, achieved improvement in walking distance comparable with supervised exercise. Long-term results in a larger number of patients will provide valuable information on the optimal treatment modality of intermittent claudication.
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Affiliation(s)
- S K Kakkos
- Vascular Unit, Ealing Hospital, Southall, Middlesex, UK
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