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Angioplasty (versus non surgical management) for intermittent claudication

  • Review
  • Intervention

Authors

  • Gerry Fowkes,

    Corresponding author
    1. The University of Edinburgh, Wolfson Unit for Prevention of Peripheral Vascular Diseases, Edinburgh, UK
    • Gerry Fowkes, Wolfson Unit for Prevention of Peripheral Vascular Diseases, The University of Edinburgh, Department of Public Health Sciences, Teviot Place, Edinburgh, EH8 9AG, UK. gerry.fowkes@ed.ac.uk.

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  • Ian N Gillespie

    1. New Royal Infirmary of Edinburgh, Department of Radiology, EDINBURGH, UK
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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.

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.

Laički sažetak

Angioplastika u usporedbi s ne-kirurškim liječenjem za intermitentnu klaudikaciju, bol u nogama ili pri hodanju

Intermitentna klaudikacija je pojava boli prilikom hodanja, koja nestaje pri odmaranju. Bol nastaje zbog nedostatne količine krvi koja dolazi u mišiće potkoljenice prilikom tjelesne aktivnosti, najčešće zbog ateroskleroze u arterijama nogu, zbog čega je dio arterije sužen ili blokiran. Osobama s blagim oblikom bolesti savjetuje se prestanak pušenja, provođenje tjelovježbe i uzimanje niske doze acetilsalicilne kiselina kako bi se spriječio srčani ili moždani udar. Nema općenito prihvaćenog oblika liječenja za taj poremećaj. Angioplastika je zahvat u kojem se koristi balon, laserski ili mehanički uređaj koji se uvodi u arteriju noge kako bi se arterija proširila i kako bi se otvorio suženi ili začepljeni dio arterije. Moguće štetne posljedica zahvata uključuju nastanak krvnih ugrušaka i pomicanje tih krvnih ugrušaka i komadića tkiva (embolusa) u krvotoku. Liječenje može dovesti do trenutnog ublažavanja simptoma, ali se suženje može ponovo javiti.

Pronađena su 2 kontrolirana istraživanja. Oba su provedena u Velikoj Britaniji. U njima je sudjelovalo ukupno 98 ispitanika. Njihova prosječna dob bila je 62 godine, i među njima je bilo svega 20 žena. Ispitanici su nasumično raspoređeni u skupine. Terapijska skupina je u oba istraživanja primala angioplastiku. Kontrolna skupina je u jednom istraživanju primala program tjelovježbe, dok je u drugom istraživanju angioplastika uspoređena s djelovanjem savjeta o pušenju, uzimanju acetilsalicilne kiseline i tjelovježbe. Nakon 6 mjeseci oba istraživanja su opisala poboljšanja u protoku krvi kroz nogu u osoba koje su primile angioplastiku, što je dokazano usporedbom tlaka u potkoljenici i ruci - tzv. srednji gležanjski tlak (engl. mean ankle brachial pressure index). U jednom istraživanju se udaljenost hodanja na pokretnoj traci više poboljšala u ispitanika koji su primili tjelovježbu nego angioplastiku nakon 6 mjeseci i nakon 1 godine. Nisu utvrđene koristi od angioplastike 6 godina nakon kirurškog zahvata. U drugom istraživanju je tijek krvi i dalje bio poboljšan 2 godine nakon angioplastike, ali duljina hodanja bez boli, koja se bila poboljšala nakon 6 mjeseci, i kvaliteta života, nisu bili bolji u odnosu na ispitanike koji su primili samo savjet. Pronađena su samo ta dva istraživanja, koja su uključila relativno malen broj ispitanika, i koja daju zaključak da angioplastika omogućuje samo kratkotrajni koristan učinak.

Bilješke prijevoda

Hrvatski Cochrane
Prevela: Livia Puljak
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr

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