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PubMedDate not supplied

Aortofemoral thromboendarterectomy.

PURPOSE: To study whether endarterectomy is feasible in all patients with aortofemoral atherosclerotic obstruction, considering early and late results. METHODS: A clinical, prospective, and descriptive study carried out in a university hospital. Inclusion criteria were atherosclerotic aortofemoral obstructive disease, clinical status compatible with major surgery, and absence of prior restorative procedure. Exclusion criteria were aneurysm, inflammatory arterial disease, and prior restorative procedure found during surgery. Eighty patients entered the protocol, but 9 were excluded (11.2%). Seventy-one patients, mean age of 57.3 years, underwent endarterectomy. Operative indications were intermittent claudication and critical ischemia. A ring-stripper endarterectomy technique was employed in all patients. Results were related to age, gender, symptoms, presence of diabetes mellitus, extension of endarterectomy, and extent of obstructive disease. Chi square or Fisher exact tests were used when appropriate, and the Wilkoxon (Gehan) test was used to compare survival curves. RESULTS: Sixty-eight (100%) endarterectomies were patent at discharge. The mortality rate was 4.2%. The amputation rate (4.3%) was higher in diabetic patients and when there was associated femoropopliteal obstruction. The 5-year survival rate was 83.3%, and late deaths were mostly cardiovascular. Diabetes mellitus, age above 65 years, and associated femoropopliteal obstruction lowered the survival rate. The 5-year patency rate was 87.0%. Critical ischemia and less extensive endarterectomies were associated with a lower patency rate. There were no anastomotic aneurysms or deep infections. CONCLUSIONS: Aortofemoral thromboendarterectomy is feasible in 90% of patients, early mortality rate is low, diabetic patients and those with associated femoropopliteal obstructive disease have a higher mortality rate, amputation rate is low, late deaths are mostly cardiovascular, and late patency rate is high, and even higher in the intermittent claudication group.

Aged↗
PubMed1999

Vascular surgical society of great britain and ireland: superficial femoral angioplasty

BACKGROUND: Superficial femoral angioplasty (percutaneous transluminal angioplasty, PTA) is a widely performed therapeutic modality used throughout the UK in the treatment of intermittent claudication. However, there is still concern over its efficacy in the management of atherosclerotic occlusive disease. Long-term outcome was examined in patients undergoing PTA for short (less than 10 cm) occlusions or stenoses. METHODS: Data were collected prospectively for 413 patients undergoing femoral angioplasty and entered into a database for long-term outcome analysis. Patients were seen at 3, 6 and 12 months and at yearly intervals. Doppler ultrasonography and clinical assessment were performed in all patients and duplex imaging was carried out in those in whom there was doubt about patency. Finally, surviving patients were simply questioned as to whether they felt the original PTA to have been worthwhile. RESULTS: Mean follow-up time was 7 (range 2-11) years. Excluding an initial technical failure rate of 8 per cent, cumulative primary patency at 1, 2, 3, 4 and 5 years was 64, 55, 36, 21 and 14 per cent respectively. Moreover, clinical assessment revealed improvement of the presenting complaint in only 40, 29, 17, 9 and 7 per cent respectively. CONCLUSION: Superficial femoral PTA does not appear to be effective in the management of intermittent claudication in most patients.

Journal Article↗
PubMed2003

Prevalence and major risk factors of reduced flow volume in lower extremities with normal ankle-brachial index in Japanese patients with type 2 diabetes.

OBJECTIVE: To clarify the prevalence and major risk factors of reduced flow volume in lower extremities with normal ankle-brachial index (ABI) in Japanese patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: We recruited 208 consecutive type 2 diabetic patients and 33 age-matched nondiabetic subjects (control group) admitted to our hospital. Thirty-two of the patients had low ABI (<0.90) and intermittent claudication (peripheral arterial disease [PAD] group), and 176 patients had normal ABI (>0.9) (non-PAD group). We evaluated flow volume and resistive index, as an index of arterial resistance to blood flow, at the popliteal artery using gated two-dimensional cine-mode phase-contrast magnetic resonance imaging. RESULTS: Simple linear regression analysis showed a negative correlation between resistive index and total flow volume in the non-PAD group (r = -0.714, P < 0.001). We defined the means +/- 2 SD of these parameters in the control group as the normal range; abnormal resistive index was >1.017, and abnormal flow volume was <50.8 ml/min. The non-PAD group was divided according to the levels of these parameters: 80 patients had both normal resistive index and normal flow volume (normal group); of 96 patients with higher resistive index, 63 had normal flow volume (borderline group) and 33 had reduced flow volume (reduced group). Multiple regression analysis demonstrated that the major risk factors for reduced flow volume were age, hypertension, and diabetic nephropathy (r(2) = 0.303, P < 0.001). CONCLUSIONS: The prevalence of patients without PAD with reduced flow volume in the lower extremities was 16% (n = 33) and comparable with that of patients with PAD with intermittent claudication (n = 32), suggesting that increase in arterial resistance to blood flow may be one of the major causes of lower extremity arterial disease in Japan.

Aged↗
PubMed1996

Oral naftidrofuryl. A review of its pharmacology and therapeutic use in the management of peripheral occlusive arterial disease.

Naftidrofuryl has been used for the treatment of intermittent claudication, a symptom of mild to moderate peripheral occlusive arterial disease (POAD), for at least 2 decades. As a serotonin 5-HT2 receptor antagonist, naftidrofuryl has vasoactive properties in addition to its favourable effects on oxidative metabolism, peripheral transcutaneous oxygen pressure and the rheological properties of platelets and erythrocytes. The drug may also reduce hypercholesterolaemia-induced intimal proliferation. Clinical trials which conform best with European guidelines have shown that 3 and 6 months' oral therapy with naftidrofuryl 600 or 633 mg/day (in 3 or 2 divided doses) increased pain-free walking distance to a greater extent than placebo administration in patients with POAD. Surgical revascularisation was required less often during 6 months of therapy with naftidrofuryl than in placebo recipients, confirming the superiority of naftidrofuryl treatment compared with placebo. Available data provide some evidence of efficacy of the drug in the treatment of ischaemic rest pain and vascular ulceration. However, further trials are required before the usefulness of oral naftidrofuryl in severe POAD can be fully established. When given orally, naftidrofuryl is well tolerated. Mild gastrointestinal effects are the most common adverse events, requiring withdrawal of therapy in approximately 1.2% of patients compared with 0.95% of placebo-treated patients. In summary, oral naftidrofuryl improves the symptoms of intermittent claudication in patients with POAD with minimal risk of adverse effects. Therefore, in patients with Fontaine's classification stage II POAD for whom lifestyle modifications and management of concomitant disease have provided insufficient benefit, naftidrofuryl is potentially useful.

Arterial Occlusive Diseases↗
PubMed2005

Assessment of smoking status in patients with peripheral arterial disease.

OBJECTIVE: To assess the utility of a novel rapid urinary cotinine assay to detect and quantify the level of smoking in patients with peripheral arterial disease. METHODS: This was a cross-sectional study in a vascular surgical outpatient department of a large teaching hospital. Participants were 100 consecutive subjects presenting to a hospital outpatient clinic with a diagnosis of intermittent claudication confirmed by a positive Edinburgh claudication questionnaire and an ankle-brachial pressure index of less than 0.9. Main outcome measures were patient-offered smoking history, exhaled breath carbon monoxide levels, urinary cotinine levels as measured by a novel rapid assay, and laboratory-measured creatinine-adjusted urinary cotinine levels. Results Fifty-five subjects declared that they were current smokers, 40 declared that they were ex-smokers, and 5 declared that they were never-smokers. Of the 40 ex-smokers, 6 subjects (15%) had urinary cotinine levels greater than 500 ng/mL (regular smokers), and a further 2 (5%) had urinary cotinine levels between 100 and 500 ng/mL (light, irregular, or passive smokers). The rapid urinary cotinine assay had a sensitivity and specificity of 100% and 98%, respectively, in its ability to detect active smoking, and the degree of smoking correlated well with laboratory creatinine-corrected urinary cotinine levels (Spearman coefficient, 0.805; P < .001). By contrast, exhaled carbon monoxide had a sensitivity and specificity of 95% and 89%, respectively, and although it correlated well with urinary cotinine (Spearman coefficient, 0.782; P < .001), it was found on linear regression analysis to be unreliable in differentiating light smokers from nonsmokers. CONCLUSIONS: Patient-offered smoking history is unreliable because there is no correlation between the patient-reported number of cigarettes smoked per day and urinary cotinine levels. The novel rapid assay for urinary cotinine described here is superior to exhaled carbon monoxide measurement in detecting the level of smoking exposure among patients with intermittent claudication, and its results correlate well with laboratory-measured cotinine.

Aged↗
PubMed1998

Ranolazine Roche Bioscience.

Ranolazine is a metabolic modulator developed by Syntex (Roche) and is in phase III clinical trials as an anti-anginal agent and for the treatment of peripheral arterial disease, particularly intermittent claudication. It allows maintenance of energy output by muscle cells under hypoxic conditions. Ranolazine may be especially useful in angina patients in whom other therapies are ineffective. The licensee, CV Therapeutics (CVT), began a pivotal placebo-controlled, phase III clinical trial of ranolazine in October 1997 enrolling 150 angina patients [265551]. CVT plans to begin a second phase III trial in 350 to 400 angina patients receiving other anti-anginal medications during 1998 [279177]. Clinical studies suggest that ranolazine lowers the heart's demand for oxygen by increasing its ability to use carbohydrate, rather than fat, as a fuel. This is thought to be due to activation of pyruvate dehydrogenase and modulation of the activities of L-type calcium channels. This is achieved without reducing heart rate or blood pressure, or impairing pumping ability [253375,247228]. Ranolazine has been tested in more than 1300 US and European patients in phase I and phase II clinical trials, and is now being evaluated in a placebo-controlled, double-blind multicenter study to determine its effectiveness in treating stable angina. Phase II trials, in over 1200 patients with ischemic heart disease, were completed by Syntex. They demonstrated increased exercise times to onset of angina or electrocardiographic change associated with insufficient blood flow to the heart with three times daily dosing of ranolazine [224364]. Roche Bioscience claims that in the US and Western Europe approximately 1.4 million angina patients are not adequately treated with existing therapies and some 5 million patients suffer from intermittent claudication [166817]. In August 1998, CV Therapeutics signed an agreement with Catalytica Pharmaceuticals, which will manufacture specified quantities of ranolazine for use in clinical trials [293333].

Journal Article↗
PubMed1995

Association of serum C3 levels with the risk of myocardial infarction.

PURPOSE: Serum complement and IgA levels have been found to be retrospectively associated with the presence of diffuse atherosclerosis. This study was performed to assess whether serum immunoglobulins and complement components are predictive of future ischemic events. PATIENTS AND METHODS: The baseline values of IgG, IgA, IgM, C3, and C4 were measured in the sera from a cohort of 860 inhabitants of the town of Brisighella, Italy. They were 444 men and 416 women, mean age 53.9 years (SD 12.4, range 23 to 84), who had not had any ischemic events (myocardial infarction [MI], angina pectoris, stroke, transient ischemic attack, or intermittent claudication) at the time of blood sampling in 1984. Their baseline values for the main recognized risk factors for atherosclerosis were known at baseline and for 4 years of follow-up. Multiple logistic regression analysis was performed for associations between ischemic events and immunologic variables (including serum IgG, IgA, IgM, C3, and C4) and risk factors for atherosclerosis (including age, sex, diastolic blood pressure, cigarette consumption, Quetelet index, total cholesterol, HDL cholesterol, triglycerides and blood glucose). RESULTS: During follow-up, 57 subjects experienced ischemic events, including 28 cases of coronary heart disease (17 MI and 11 angina pectoris). Of the immunologic variables studied, only serum C3 was found to be independently associated with ischemic events (P < 0.005 for any ischemic events, coronary heart disease, and MI). The population was divided into thirds according to C3 values. The cumulative incidence of MI was 7.1/1,000 in the low third, 10.6/1,000 in the middle third and 40.8/1,000 in the high third (risk ratio for high versus middle plus low = 4.2 after adjustment for age and sex; 95% CI 1.5 to 11.7). A separate analysis for the sexes showed that serum C3 was a particularly powerful predictor of MI in men. Men whose C3 levels were in the top third had a 72.6/1,000 incidence of MI while the incidence in the rest of the male population was 6.2/1,000 (risk ratio 10.7 after adjustment for age; 95% CI 2.3 to 49.0). When similar analyses were performed for angina pectoris, stroke, and intermittent claudication, no significant increase in risk was found to be associated with serum C3. CONCLUSION: C3 levels measured in sera from male subjects without previous ischemic events are independently associated with the risk of MI.

Adult↗
PubMed2002

Beraprost: a review of its pharmacology and therapeutic efficacy in the treatment of peripheral arterial disease and pulmonary arterial hypertension.

UNLABELLED: Beraprost sodium (beraprost) is a stable, orally active prostacyclin analogue with vasodilatory, antiplatelet and cytoprotective effects. Beraprost acts by binding to prostacyclin membrane receptors ultimately inhibiting the release of Ca2+ from intracellular storage sites. This reduction in the influx of Ca2+ has been postulated to cause relaxation of the smooth muscle cells and vasodilation. Data from a large, randomised, double-blind, multicentre study indicated that beraprost was as efficacious as ticlopidine in the treatment of patients with peripheral arterial disease (Buerger's disease and arteriosclerosis obliterans). Most patients receiving beraprost exhibited reduction of ulcer size, reported improvement of granulation appearance of the tissue and showed improvement of pain at rest and sensation of cold in the extremities. In a large pivotal clinical trial in patients with intermittent claudication, beraprost treatment was associated with statistically significant increases in pain-free and absolute walking distances compared with those in patients receiving placebo. Statistically significant differences in the incidence of critical cardiovascular events among both treatment groups were not observed but patients receiving beraprost were more likely to be satisfied with changes in their quality of life. However, while preliminary unpublished data from a large, phase III, placebo-controlled study in the US suggested a trend toward fewer critical cardiovascular events (no specific data presented), this study did not confirm the positive results from the European phase III trial and statistical significance was not achieved in the study's endpoints relating to exercise. A series of small, noncomparative clinical trials of patients with the rare condition of pulmonary arterial hypertension (PAH) demonstrated that substantial reductions of pulmonary arterial pressure and resistance, increase of cardiac output, and increase of exercise capacity appeared to be associated with beraprost therapy; however, these data are very limited and in most instances are not fully published. Beraprost is a well tolerated agent. Overall, the main adverse events include headache, hot flushes, diarrhoea and nausea. However, patients with PAH showed higher incidence of adverse events than those with peripheral arterial disease. CONCLUSION: Beraprost, an orally administered PGI2 analogue, is generally well tolerated and appears to be an effective agent in the treatment of patients with Buerger's disease and arteriosclerosis obliterans. Comparative data from a large randomised trial indicated that the drug appears as effective as ticlopidine in patients with these conditions. In patients with intermittent claudication, significant benefits of beraprost compared with placebo were reported in a randomised clinical trial; however, the use of beraprost in these patients is not supported by recent preliminary unpublished data from a large, phase III, placebo-controlled study. Limited data suggest some efficacy with long-term beraprost treatment of patients with PAH, where options are few and where oral administration of the drug could be a considerable advantage over intravenous prostacyclin (PGI2) therapy. Additional well-designed and, where possible, large trials with active comparators are necessary to define more precisely the place of beraprost in the treatment of patients with PAH, Buerger's disease and arteriosclerosis obliterans.

Animals↗
PubMed1999

Comparison of the effects of cilostazol and milrinone on intracellular cAMP levels and cellular function in platelets and cardiac cells.

Cilostazol is a potent cyclic nucleotide phosphodiesterase (PDE) type 3 (PDE3) inhibitor that was recently approved by the Food and Drug Administration (FDA) for the treatment of intermittent claudication. Its efficacy is presumed to be due to its vasodilatory and platelet activation inhibitory activities. Compared with those treated with placebo, patients treated with cilostazol showed a minimal increase in cardiac adverse events. Because of its PDE3 inhibitory activity, however, the possibility that cilostazol exerts positive cardiac inotropic effects is a safety concern. Therefore we compared the effects of cilostazol with those of milrinone, a selective PDE3 inhibitor, on intracellular cyclic adenosine monophosphate (cAMP) levels in platelets, cardiac ventricular myocytes, and coronary smooth muscle cells. We also compared the corresponding functional changes in these cells. Cilostazol and milrinone both caused a concentration-dependent increase in the cAMP level in rabbit and human platelets with similar potency. Furthermore, cilostazol and milrinone were equally effective in inhibiting human platelet aggregation with a median inhibitory concentration (IC50) of 0.9 and 2 microM, respectively. In rabbit ventricular myocytes, however, cilostazol elevated cAMP levels to a significantly lesser extent (p < 0.05 vs. milrinone). By using isolated rabbit hearts with a Langendorff preparation, we showed that milrinone is a very potent cardiotonic agent; it concentration-dependently increased left ventricular developed pressure (LVDP) and contractility. Cilostazol was less effective in increasing LVDP and contractility (p < 0.05 vs. milrinone), which is consistent with the cardiac cAMP levels. The cardiac effect of OPC-13015, a metabolite of cilostazol with about sevenfold higher PDE3 inhibition, was similar to cilostazol. Whereas milrinone concentration-dependently increased cAMP in rabbit coronary smooth muscle cells, cilostazol did not have such an effect. However, both compounds increased coronary flow equally in rabbit hearts. Our results show that although cilostazol and milrinone both inhibit PDE3, cilostazol preferentially acts on vascular elements (platelets and flow). This unique profile of cilostazol is consistent with its beneficial and safe clinical outcomes in patients with intermittent claudication.

Animals↗
PubMed1975

[Arterielle occlusion in two leg amputees ("phantom claudication" due to pelvic-artery stenosis) (author's transl)].

Signs of intermittent claudication in the phantom leg developed in two patients 18 and 27 years, respectively, after mid-thigh amputation. Symptomatic treatment of the phantom pain was without success. Clinical, oscillographic and angiographic studies demonstrated atherosclerotic arterial stenoses of the iliac arteries. After successful vascular reconstruction (iliac-femoral and aortic-femoral bypass, respectively) on the side of amputation both patients are without pain or other symptoms and can again walk with restriction.

Angiography↗
PubMed1995

Exercise rehabilitation programs for the treatment of claudication pain. A meta-analysis.

OBJECTIVE: To identify the components of exercise rehabilitation programs that were most effective in improving claudication pain symptoms in patients with peripheral arterial disease. DATA SOURCES: English-language articles were identified by a computer search using Index Medicus and MEDLINE, followed by an extensive bibliography review. STUDY SELECTION: Studies were included if they provided the mean or individual walking distances or times to the onset of claudication pain and to maximal pain during a treadmill test before and after rehabilitation. DATA EXTRACTION: Walking distances and times and characteristics of the exercise programs were independently abstracted by two observers. DATA SYNTHESIS: Thirty-three English-language studies were identified, of which 21 met the inclusion criteria. Overall, following a program of exercise rehabilitation, the distance (mean +/- SD) to onset of claudication pain increased 179% from 125.9 +/- 57.3 m to 351.2 +/- 188.7 m (P < .001), and the distance to maximal claudication pain increased 122% from 325.8 +/- 148.1 m to 723.3 +/- 591.5 m (P < .001). The greatest improvement in pain distances occurred with the following exercise program: duration greater than 30 minutes per session, frequency of at least three sessions per week, walking used as the mode of exercise, use of near-maximal pain during training as claudication pain end point, and program length of greater than 6 months. However, the claudication pain end point, program length, and mode of exercise were the only independent predictors (P < .001) for improvement in distances. CONCLUSIONS: The optimal exercise program for improving claudication pain distances in patients with peripheral arterial disease uses intermittent walking to near-maximal pain during a program of at least 6 months. Such a program should be part of the standard medical care for patients with intermittent claudication.

Exercise Test↗
PubMed1976

Popliteal artery entrapment; claudication during youth.

We report four patients who presented early in life with intermittent claudication, caused by popliteal artery entrapment. In three of them this was the result of an abnormality in the anatomy of the popliteal fossa. In the fourth, however, muscular hypertrophy alone led to arterial entrapment. Three patients were successfully treated by simple myotomy. In the fourth arteriography showed a total occlusion of the popliteal artery. An arteriotomy was performed. In was then seen that the vessel was still patent, and the opening was closed with a vein patch. The result of this procedure was also satisfactory. It is the authors' opinion, based on their own experience and that of other workers as reported in the literature, that vascular reconstruction is only indicated when irreversible vascular changes have occurred, or where other lesions have complicated the condition.

Adolescent↗
PubMed1988

[Spinal claudication following ileocaval venous thrombosis].

The case is reported of a young male who presented with intermittent claudication after thrombosis of the right common femoral, iliac and caval vein. The symptoms were explained by the severe proximal venous obstruction. The patient, however, also complained of lumbar pain during and long after walking, and showed signs of irritation of nerve roots L4 to S1 on the right side. Venography and CT-scan disclosed venous collateral circulation leading through the spinal canal. The blood drained through the foramina intervertebralia to the caval vein, causing compression of the nerve roots depending on their filling. Thus, the claudication was "venous" in two ways, muscular (due to inadequate drainage) and spinal (due to intermittent compression of lumbar nerve roots by the collateral circulation).

Adult↗
PubMedDate not supplied

Venous claudication. A report of 15 cases and a review of the literature.

The symptom of intermittent claudication is not invariably due to arterial disease. Exercise-related pain resulting from venous insufficiency is poorly defined, but has been described by a number of authors in the past. Fifteen patients with symptoms suggestive of venous claudication are reported. The history and clinical findings are described. The further investigation of these patients is outlined, starting with the non-invasive methods of Doppler ultrasonography and strain gauge plethysmography. Ascending phlebography was performed on all affected limbs (n. 19) and descending phlebography was performed on those shown to have a patent deep venous system. These investigations demonstrated deep venous abnormalities associated with the distinct symptom complex. Venous claudication is defined and the literature reviewed. It is hoped that a clearer understanding of the condition will result in more frequent and accurate diagnosis with subsequent benefit to the patient.

Adult↗
PubMed1999

Peripheral blood flow rates and microvascular responses to orthostatic pressure changes in claudicants before and after revascularisation.

OBJECTIVES: To study the effect of arterial reconstruction for occlusive atherosclerotic disease with intermittent claudication on blood flow rate during rest and on microvascular responses to orthostatic pressure changes in the pulp skin of the first toe where arteriovenous anastomoses are numerous. MATERIAL: Eleven patients with Fontaine IIa claudication (ankle blood pressure index > 0.30) before and 7 (range: 2-11) months after intervention. METHODS: Blood flow rate was measured by the heat washout method with the toe at heart level and after passive lowering to 50 cm below this level using a Clark type electrode with thermostatically controlled cap that was fixed to the pulp of the first toe by adhesive tape. RESULTS: At heart level, blood flow rate was lower in claudicants before reconstruction as compared to a group of previously published control subjects (p = 0.0076, Wilcoxon), blood flow rate increased in claudicants from before to after intervention (p = 0.0128), and postoperative blood flow rate was like that of normals (N.S.). Before surgery, blood flow rate in claudicants increased in median with a factor of 1.79 during lowering (p < 0.0051). CONCLUSIONS: The disturbance of the microcirculatory responses to orthostatically induced pressure changes in claudicants reverted towards normal after arterial reconstruction.

Aged↗
PubMed1992

Claudication induces systemic capillary endothelial swelling.

An in vivo model of intermittent claudication has been developed to investigate systemic reperfusion injury associated with transient muscle ischaemia. Rats were subjected to unilateral common iliac artery ligation and two weeks of intermittent hind limb muscle stimulation. Electron microscopy demonstrated a significantly increased percentage of swollen capillary endothelial cells both locally and systemically in these "claudicant" rats, compared with controls or those undergoing muscle stimulation or artery ligation alone. These results support human data suggesting that claudication induces an inflammatory response which results in systemic vascular injury.

Animals↗
PubMed2004

Cost-effectiveness of exercise training to improve claudication symptoms in patients with peripheral arterial disease.

Exercise rehabilitation is a proven, yet poorly available, treatment for intermittent claudication, the primary symptom of peripheral arterial disease (PAD). Exercise rehabilitation is effective, non-invasive, and associated with minimal cardiovascular risk in appropriate patients. Percutaneous transluminal angioplasty (PTA), especially of the iliac segment, is an alternative effective treatment for claudication. There are, however, minimal data currently available to compare the cost-effectiveness of these two interventions. We compared the cost-effectiveness of 3- and 6-month exercise programs with that of iliac PTA without stenting, using the incremental cost-effectiveness ratio [ICER = (Cost2 - Cost1)/(Effectiveness2 - Effectiveness1)]. The ICER represented the price of an additional meter walked derived from each treatment based on conservative models of success of each procedure and specific care assumptions. PTA and exercise efficacy data were derived from a literature review and exercise costs were modeled per the current CPT code 93668. Effectiveness was defined as absolute claudication distance (ACD) at 3 and 6 months. Three treatment alternatives were assessed: (1) no treatment, (2) PTA, and (3) exercise rehabilitation. At 3 months, PTA was more effective than exercise therapy and resulted in an additional 38 meters at an additional cost of $6719, for an ICER of $177/meter. At 6 months, however, exercise was more effective than PTA, resulting in an additional 137 meters walked, and costs less ($61 less per meter gained). In conclusion, exercise rehabilitation at 6 months is more effective and costs less than PTA, and is therefore cost-saving. The cost-effectiveness and availability of claudication treatments has national implications for future PAD care; however, data to inform these care choices can best be obtained in prospective clinical trials.

Angioplasty, Balloon↗