Skip to main content

Intermittent Claudication

  • Chapter
  • First Online:
Evidence-based Therapy in Vascular Surgery

Abstract

Patients with intermittent claudication should primarily be offered supervised exercise training. Endovascular revascularization is considered when exercise fails to achieve an adequate symptomatic improvement. Open surgery is only the third option, recommended when the alternative treatment options are logistically or technically unfeasible or have proven unsuccessful.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Aherne T, McHugh S, Kheirelseid EA, Lee MJ, McCaffrey N, Moneley D, Leahy AL, Naughton P. Comparing supervised exercise therapy to invasive measures in the management of symptomatic peripheral arterial disease. Surg Res Pract. 2015;2015:960402.

    PubMed  PubMed Central  Google Scholar 

  • Al-Jundi W, Madbak K, Beard JD, Nawaz S, Tew GA. Systematic review of home-based exercise programmes for individuals with intermittent claudication. Eur J Vasc Endovasc Surg. 2013;46:690–706.

    Article  CAS  PubMed  Google Scholar 

  • Ambler GK, Radwan R, Hayes PD, Twine CP. Atherectomy for peripheral arterial disease. Cochrane Database Syst Rev. 2014;3:CD006680.

    Google Scholar 

  • Anderson JL, Halperin JL, Albert NM, et al. Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127:1425–43.

    Article  PubMed  Google Scholar 

  • Andras A, Hansrani M, Stewart M, Stansby G. Intravascular brachytherapy for peripheral vascular disease. Cochrane Database Syst Rev. 2014;(1):CD003504.

    Google Scholar 

  • BuliĹ„ska K, Kropielnicka K, JasiĹ„ski T, et al. Nordic pole walking improves walking capacity in patients with intermittent claudication: a randomized controlled trial. Disabil Rehabil. 2016;38:1318–24.

    Article  PubMed  Google Scholar 

  • Chowdhury MM, McLain AD, Twine CP. Angioplasty versus bare metal stenting for superficial femoral artery lesions. Cochrane Database Syst Rev. 2014;(6):CD006767.

    Google Scholar 

  • Conte MS, Pomposelli FB, Clair DG, et al. ; Society for Vascular Surgery Lower Extremity Guidelines Writing Group. Society for vascular surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Vasc Surg. 2015;61(3 Suppl):2S–41S.

    Google Scholar 

  • Dake MD, Ansel GM, Jaff MR, et al. ; Zilver PTX investigators. Durable clinical effectiveness with paclitaxel-eluting stents in the femoropopliteal artery: 5-year results of the Zilver PTX randomized trial. Circulation. 2016;133:1472–83.

    Google Scholar 

  • Fakhry F, Rouwet EV, den Hoed PT, Hunink MG, Spronk S. Long-term clinical effectiveness of supervised exercise therapy versus endovascular revascularization for intermittent claudication from a randomized clinical trial. Br J Surg. 2013;100:1164–71.

    Article  CAS  PubMed  Google Scholar 

  • Fakhry F, Spronk S, van der Laan L, et al. Endovascular Revascularization and Supervised Exercise for peripheral artery disease and intermittent claudication: a randomized clinical trial. JAMA. 2015;314:1936–44.

    Article  CAS  PubMed  Google Scholar 

  • Fokkenrood HJ, Bendermacher BL, Lauret GJ, Willigendael EM, Prins MH, Teijink JA. Supervised exercise therapy versus non-supervised exercise therapy for intermittent claudication. Cochrane Database Syst Rev. 2013;(8):CD005263.

    Google Scholar 

  • Fokkenrood HJ, Lauret GJ, Verhofstad N, Bendermacher BL, Scheltinga MR, Teijink JA. The effect of supervised exercise therapy on physical activity and ambulatory activities in patients with intermittent claudication. Eur J Vasc Endovasc Surg. 2015;49:184–91.

    Article  CAS  PubMed  Google Scholar 

  • Frans FA, Bipat S, Reekers JA, Legemate DA, Koelemay MJ. Systematic review of exercise training or percutaneous transluminal angioplasty for intermittent claudication. Br J Surg. 2012;99:16–28.

    Article  CAS  PubMed  Google Scholar 

  • Gardner AW, Montgomery PS, Parker DE. Optimal exercise program length for patients with claudication. J Vasc Surg. 2012;55:1346–54.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gardner AW, Parker DE, Montgomery PS, Blevins SM. Diabetic women are poor responders to exercise rehabilitation in the treatment of claudication. J Vasc Surg. 2014;59:1036–43.

    Article  PubMed  Google Scholar 

  • Geraghty PJ, Mewissen MW, Jaff MR, Ansel GM; VIBRANT Investigators. Three-year results of the VIBRANT trial of VIABAHN endoprosthesis versus bare nitinol stent implantation for complex superficial femoral artery occlusive disease. J Vasc Surg. 2013;58:386–95.

    Google Scholar 

  • Gommans LN, Saarloos R, Scheltinga MR, Houterman S, de Bie RA, Fokkenrood HJ, Teijink JA. Editor’s choice–the effect of supervision on walking distance in patients with intermittent claudication: a meta-analysis. Eur J Vasc Endovasc Surg. 2014;48:169–84.

    Article  CAS  PubMed  Google Scholar 

  • Gommans LN, Fokkenrood HJ, van Dalen HC, Scheltinga MR, Teijink JA, Peters RJ. Safety of supervised exercise therapy in patients with intermittent claudication. J Vasc Surg. 2015a;61:512–8.

    Article  PubMed  Google Scholar 

  • Gommans LN, Scheltinga MR, van Sambeek MR, Maas AH, Bendermacher BL, Teijink JA. Gender differences following supervised exercise therapy in patients with intermittent claudication. J Vasc Surg. 2015b;62:681–8.

    Article  PubMed  Google Scholar 

  • Gommans LN, Teijink JA. Attitudes to supervised exercise therapy. Br J Surg. 2015;102:1153–5.

    Article  CAS  PubMed  Google Scholar 

  • Jens S, Conijn AP, Koelemay MJ, Bipat S, Reekers JA. Randomized trials for endovascular treatment of infrainguinal arterial disease: systematic review and meta-analysis (Part 1: Above the knee). Eur J Vasc Endovasc Surg. 2014;47:524–35.

    Article  CAS  PubMed  Google Scholar 

  • Katsanos K, Spiliopoulos S, Karunanithy N, Krokidis M, Sabharwal T, Taylor P. Bayesian network meta-analysis of nitinol stents, covered stents, drug-eluting stents, and drug-coated balloons in the femoropopliteal artery. J Vasc Surg. 2014;59:1123–33.

    Article  PubMed  Google Scholar 

  • Katsanos K, Geisler BP, Garner AM, Zayed H, Cleveland T, Pietzsch JB. Economic analysis of endovascular drug-eluting treatments for femoropopliteal artery disease in the UK. BMJ Open. 2016a;6:e011245.

    Article  PubMed  PubMed Central  Google Scholar 

  • Katsanos K, Spiliopoulos S, Paraskevopoulos I, Diamantopoulos A, Karnabatidis D. Systematic review and meta-analysis of randomized controlled trials of paclitaxel-coated balloon angioplasty in the femoropopliteal arteries: role of paclitaxel dose and bioavailability. J Endovasc Ther. 2016b;23:356–70.

    Article  PubMed  Google Scholar 

  • Laird JR, Katzen BT, Scheinert D et al. ; RESILIENT Investigators. Nitinol stent implantation vs. balloon angioplasty for lesions in the superficial femoral and proximal popliteal arteries of patients with claudication: three-year follow-up from the RESILIENT randomized trial. J Endovasc Ther. 2012;19:1–9.

    Google Scholar 

  • Laird JR, Schneider PA, Tepe G, et al. ; IN.PACT SFA Trial Investigators. Durability of treatment effect using a drug-coated balloon for femoropopliteal lesions: 24-month results of IN.PACT SFA. J Am Coll Cardiol. 2015;66: 2329–38.

    Google Scholar 

  • Lammer J, Zeller T, Hausegger KA, et al. Sustained benefit at 2 years for covered stents versus bare-metal stents in long SFA lesions: the VIASTAR trial. Cardiovasc Intervent Radiol. 2015;38:25–32.

    Article  PubMed  Google Scholar 

  • Lane R, Ellis B, Watson L, Leng GC. Exercise for intermittent claudication. Cochrane Database Syst Rev. 2014;(7):CD000990.

    Google Scholar 

  • Lauret GJ, van Dalen HC, Hendriks HJ, van Sterkenburg SM, Koelemay MJ, Zeebregts CJ, Peters RJ, Teijink JA. When is supervised exercise therapy considered useful in peripheral arterial occlusive disease? A nationwide survey among vascular surgeons. Eur J Vasc Endovasc Surg. 2012;43:308–12.

    Article  CAS  PubMed  Google Scholar 

  • Lauret GJ, Fakhry F, Fokkenrood HJ, Hunink MG, Teijink JA, Spronk S. Modes of exercise training for intermittent claudication. Cochrane Database Syst Rev. 2014;(7):CD009638.

    Google Scholar 

  • Lindgren H, Gottsäter A, Qvarfordt P, Bergman S, TroĂ«ng T. Invasive treatment for infrainguinal claudication has satisfactory 1 year outcome in three out of four patients: a population-based analysis from Swedvasc. Eur J Vasc Endovasc Surg. 2014;47:615–20.

    Article  CAS  PubMed  Google Scholar 

  • Malgor RD, Alahdab F, Elraiyah TA, et al. A systematic review of treatment of intermittent claudication in the lower extremities. J Vasc Surg. 2015;61(3 Suppl):54S–73S.

    Article  PubMed  Google Scholar 

  • Mazari FA, Khan JA, Carradice D, Samuel N, Abdul Rahman MN, Gulati S, Lee HL, 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. 2012;99:39–48.

    Article  CAS  PubMed  Google Scholar 

  • Mazari FA, Khan JA, Carradice D, Samuel N, Gohil R, McCollum PT, Chetter IC. Economic analysis of a randomized trial of percutaneous angioplasty, supervised exercise or combined treatment for intermittent claudication due to femoropopliteal arterial disease. Br J Surg. 2013;100:1172–9.

    Article  CAS  PubMed  Google Scholar 

  • Murphy TP, Cutlip DE, Regensteiner JG, et al. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • NICE National Institute for Health and Care Excellence. Peripheral arterial disease: diagnosis and management. NICE guidelines [CG147]. 2012. https://www.nice.org.uk/guidance/CG147/chapter/1-Guidance.

  • Olin JW, White CJ, Armstrong EJ, Kadian-Dodov D, Hiatt WR. Peripheral artery disease: evolving role of exercise, medical therapy, and endovascular options. J Am Coll Cardiol. 2016;67:1338–57.

    Article  PubMed  Google Scholar 

  • Parmenter BJ, Dieberg G, Phipps G, Smart NA. Exercise training for health-related quality of life in peripheral artery disease: a systematic review and meta-analysis. Vasc Med. 2015;20:30–40.

    Article  PubMed  Google Scholar 

  • Peeters Weem SM, van Haelst ST, den Ruijter HM, Moll FL, de Borst GJ. Lack of evidence for dual antiplatelet therapy after endovascular arterial procedures: a meta-analysis. Eur J Vasc Endovasc Surg. 2016;52(2):253–62.

    Article  CAS  PubMed  Google Scholar 

  • Reynolds MR, Apruzzese P, Galper BZ, Murphy TP, Hirsch AT, Cutlip DE, Mohler 3rd ER, Regensteiner JG, Cohen DJ. Cost-effectiveness of supervised exercise, stenting, and optimal medical care for claudication: results from the Claudication: exercise versus endoluminal revascularization (CLEVER) trial. J Am Heart Assoc. 2014;3:e001233.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rosenfield K, Jaff MR, White CJ et al.; LEVANT 2 Investigators. Trial of a paclitaxel-coated balloon for femoropopliteal artery disease. N Engl J Med. 2015;373:145–53.

    Google Scholar 

  • Sachs T, Pomposelli F, Hamdan A, Wyers M, Schermerhorn M. Trends in the national outcomes and costs for claudication and limb threatening ischemia: angioplasty vs bypass graft. J Vasc Surg. 2011;54:1021–31.

    Article  PubMed  Google Scholar 

  • Saxton JM, Zwierska I, Blagojevic M, Choksy SA, Nawaz S, Pockley AG. Upper- versus lower-limb aerobic exercise training on health-related quality of life in patients with symptomatic peripheral arterial disease. J Vasc Surg. 2011;53:1265–73.

    Article  PubMed  Google Scholar 

  • Scheinert D, Duda S, Zeller T, Krankenberg H, Ricke J, Bosiers M, Tepe G, Naisbitt S, Rosenfield K. The LEVANT I (Lutonix paclitaxel-coated balloon for the prevention of femoropopliteal restenosis) trial for femoropopliteal revascularization: first-in-human randomized trial of low-dose drug-coated balloon versus uncoated balloon angioplasty. JACC Cardiovasc Interv. 2014;7:10–9.

    Article  PubMed  Google Scholar 

  • Simpson EL, Kearns B, Stevenson MD, Cantrell AJ, Littlewood C, Michaels JA. Enhancements to angioplasty for peripheral arterial occlusive disease: systematic review, cost-effectiveness assessment and expected value of information analysis. Health Technol Assess. 2014;18:1–252.

    Article  PubMed  PubMed Central  Google Scholar 

  • Spafford C, Oakley C, Beard JD. Randomized clinical trial comparing Nordic pole walking and a standard home exercise programme in patients with intermittent claudication. Br J Surg. 2014;101:760–7.

    Article  CAS  PubMed  Google Scholar 

  • Spronk S, Bosch JL, den Hoed PT, Veen HF, Pattynama PM, Hunink MG. Cost-effectiveness of endovascular revascularization compared to supervised hospital-based exercise training in patients with intermittent claudication: a randomized controlled trial. J Vasc Surg. 2008;48:1472–80.

    Article  PubMed  Google Scholar 

  • Stoner MC, Calligaro KD, Chaer RA, Dietzek AM, Farber A, Guzman RJ, Hamdan AD, Landry GJ, Yamaguchi DJ; Society for Vascular Surgery. Reporting standards of the Society for Vascular Surgery for endovascular treatment of chronic lower extremity peripheral artery disease: executive summary. J Vasc Surg. 2016;64:227–28.

    Google Scholar 

  • Tendera M, Aboyans V, Bartelink ML, et al. ; European Stroke Organisation; ESC Committee for Practice Guidelines. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2011;32:2851–906.

    Google Scholar 

  • Tepe G, Schnorr B, Albrecht T, Brechtel K, Claussen CD, Scheller B, Speck U, Zeller T. Angioplasty of femoral-popliteal arteries with drug-coated balloons: 5-year follow-up of the THUNDER trial. JACC Cardiovasc Interv. 2015b;8:102–8.

    Article  PubMed  Google Scholar 

  • Tepe G, Laird J, Schneider P, et al. Drug-coated balloon versus standard percutaneous transluminal angioplasty for the treatment of superficial femoral and/or popliteal peripheral artery disease: 12-month results from the IN.PACT SFA randomized trial. Circulation. 2015a;131:495–502.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Vemulapalli S, Dolor RJ, Hasselblad V, Schmit K, Banks A, Heidenfelder B, Patel MR, Jones WS. Supervised vs unsupervised exercise for intermittent claudication: a systematic review and meta-analysis. Am Heart J. 2015;169:924–37.

    Article  PubMed  Google Scholar 

  • Zeller T, Rastan A, Macharzina R, Tepe G, Kaspar M, Chavarria J, Beschorner U, Schwarzwälder U, Schwarz T, Noory E. Drug-coated balloons vs. drug-eluting stents for treatment of long femoropopliteal lesions. J Endovasc Ther. 2014;21:359–68.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Debus, E.S., Grundmann, R.T. (2017). Intermittent Claudication. In: Evidence-based Therapy in Vascular Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-47148-8_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-47148-8_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-47147-1

  • Online ISBN: 978-3-319-47148-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics