Revascularization and Exercise for Intermittent Claudication

Study Questions:

Does the combination of supervised exercise and endovascular revascularization reduce claudication compared to exercise only?

Methods:

ERASE (Endovascular Revascularization And Supervised Exercise) was a randomized controlled trial of 212 patients who received endovascular revascularization with supervised exercise or supervised exercise only. Data were collected between May 17, 2010 and February 16, 2013 among patients with peripheral artery disease from 10 sites in the Netherlands. Duration of follow-up was 12 months. Intention-to-treat analysis was performed. The primary outcomes of interest included maximum treadmill walking distance at 12 months. Secondary endpoints included treadmill pain-free walking distance, 36-item short form health survey (SF-36), and a vascular quality-of-life measure (VascuQOL).

Results:

A total of 106 patients were randomized to endovascular revascularization with supervised exercise and 106 patients were randomized to supervised exercise alone. Endovascular revascularization with supervised exercise was associated with significantly greater improvement in maximal walking distance (from 264 meters to 1501 meters) compared to the supervised exercise only group (from 285 meters to 1240 meters) with a mean difference between groups of 282 meters (95% confidence interval [CI], 60-505 meters). Pain-free walking distance was also significantly greater at 12 months in the combination group compared to exercise alone (mean difference of 408 meters (95% CI, 195-622 meters). In terms of quality-of-life measures, the group receiving endovascular revascularization and supervised exercise demonstrated greater improvements in the disease-specific VascuQOL score, and the SF-36 domain of physical function.

Conclusions:

The investigators concluded that for patients with intermittent claudication, the combination of endovascular revascularization and supervised exercise was associated with significant improvement in maximal walking distance and health-related quality-of-life at 1 year.

Perspective:

These data support the value of exercise in patients with peripheral artery disease, particularly after endovascular procedures.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Vascular Medicine, Exercise

Keywords: Endovascular Procedures, Exercise, Exercise Test, Intermittent Claudication, Peripheral Arterial Disease, Quality of Life, Secondary Prevention, Walking


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