Angioplasty (versus non surgical management) for intermittent claudication
Editorial Group: Cochrane Peripheral Vascular Diseases Group
Published Online: 27 APR 1998
Assessed as up-to-date: 22 AUG 2006
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Fowkes G, Gillespie IN. Angioplasty (versus non surgical management) for intermittent claudication. Cochrane Database of Systematic Reviews 1998, Issue 2. Art. No.: CD000017. DOI: 10.1002/14651858.CD000017.
- Publication Status: Edited (no change to conclusions)
- Published Online: 27 APR 1998
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.
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.
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).
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.
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.
These limited results suggest that angioplasty may have had a short term benefit, but this may not have been sustained.
Plain language summary
Angioplasty versus conservative management of intermittent claudication, leg pain on walking
Intermittent claudication is evident as pain in the leg that becomes apparent when walking and is relieved by rest. The pain is the result of insufficient blood flow to the calf muscles when exercising, generally because of atherosclerotic changes in the leg arteries so that a section becomes narrowed or blocked. People with mild disease are advised to stop smoking, exercise, and take low-dose aspirin to prevent heart attack or stroke. There is no widely accepted medication to treat claudication. Angioplasty involves using a balloon, laser or mechanical device threaded down a leg artery to widen and open the narrowed or blocked section. Possible side effects of the procedure include blood clots and movement of blood clots and debri (emboli). The immediate effect may be to relieve the symptoms but narrowing can reoccur.
The review authors identified two controlled trials from the UK . A total of 98 participants took part. Their average age was 62 years and only 20 were women. The participants were randomised to have either angioplasty or, in one trial, to follow an exercise program or, in the other, to receive advice on smoking, aspirin and exercise. Six months later, both trials showed improvements in leg blood flow in the people who had angioplasty, measured by comparing pressures at the ankle and the arm (mean ankle brachial pressure index). In one trial, the distance walked on a treadmill improved more with exercise than angioplasty at six months and at one year. No benefits of angioplasty were evident six years after surgery. In the other trial, blood flow was still improved two years after angioplasty but walking distance without pain, which had improved at six months, and quality of life were no better than for participants receiving advice only. Only these two trials with relatively small numbers of participants contributed to the conclusion that angioplasty provides only short-term benefits.