english.prescrire.org > Spotlight > Archives : 2018 > Treating intermittent claudication: first encourage patients to follow a walking exercise programme

Spotlight: Archives

Every month, the subjects in Prescrire’s Spotlight.

2018 : 1 | 30 | 60

Treating intermittent claudication: first encourage patients to follow a walking exercise programme

FEATURED REVIEW Some patients with lower limb peripheral artery disease experience pain while walking, due to a reduced ability to increase arterial circulation. What is the harm-benefit balance of treatments aimed at improving their walking capacity?
Full review (5 pages) available for download by subscribers.

Abstract

  • For patients with intermittent claudication, what is the harm-benefit balance of treatments aimed at improving walking capacity? To answer this question, we reviewed the available evidence, using the standard Prescrire methodology.
     
  • Smoking cessation appears to reduce the risk of amputation and improve the walking capacity of patients with intermittent claudication.
     
  • Several systematic reviews have found that exercise programmes in which patients walk on a treadmill for 30 to 60 minutes, 2 to 3 times a week for 12 to 26 weeks, increase their maximum painfree walking distance by several hundred metres, with few adverse effects.
     
  • The drugs proposed to improve walking capacity have an unfavourable harm-benefit balance, due to their limited efficacy and potentially severe adverse effects.
     
  • Revascularisation does not appear to be more effective in improving walking capacity than a walking exercise programme. Walking capacity appears to improve more rapidly when walking therapy is preceded by angioplasty than with walking therapy alone.
     
  • Angioplasty provokes adverse effects in about 15% of patients, in particular bleeding, haematoma, thrombosis and distal thromboembolism. Surgery appears to carry a higher risk of adverse effects than angioplasty and to result in longer hospital stays.
     
  • As of late 2017, there is no high-quality comparative evidence on which to base the choice of revascularisation technique for patients with vascular claudication.
     
  • In practice, a walking exercise programme is the first-choice treatment for patients with intermittent claudication who want to increase their walking distance.

 

©Prescrire 1 April 2018

"Treating intermittent claudication" Prescrire Int 2018; 27 (192): 102-106. (Pdf, subscribers only)

Share Share on Facebook Share on Twitter
Download the full review.
Pdf, subscribers only