Long-Term Outcomes of Invasive vs Noninvasive Treatment for Intermittent Claudication: A Systematic Review and Meta-Analysis

Anas Elmahi, Nathalie Doolan, Mohiedin Hezima, Anwar Gowey, Daragh Moneley, Seamus McHugh, Sayed Aly, Peter Naughton, Elrasheid A. H. Kheirelseid
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Abstract

Background

Intermittent claudication (IC) is a hallmark symptom of peripheral arterial disease (PAD), causing pain and discomfort during physical activity caused by reduced blood flow to the lower extremities. The condition significantly impairs mobility and quality of life (QoL) in affected individuals. Treatment options for IC range from conservative approaches, including best medical therapy (BMT) and supervised exercise therapy (SET), to invasive interventions like angioplasty and open re-vascularization.

Aim

This meta-analysis and systematic review seek to assess the long-term results of invasive procedures concerning Noninvasive treatments for the management of patients with IC.

Methods

A comprehensive search was conducted in October 2024 across databases containing PubMed, MEDLINE, Cochrane Library, Embase, and Scopus. Randomized controlled trials (RCTs) comparing invasive interventions to Noninvasive treatments were included. Primary outcomes were quality of life (QoL), ankle-brachial pressure index (ABPI), and maximum walking distance (MWD). Secondary outcomes were major adverse cardiovascular events (MACE), mortality, complications, and re-intervention rates. Data analysis was conducted using the Cochrane Review Manager 5. Follow-up duration was between 2 and 7 years, longest available between 2 and 7 years; prioritized 2 years when present.

Results

A total of 11 RCTs with 1379 patients were included in the analysis. Invasive treatments demonstrated a significant improvement in MWD and ABPI compared to Noninvasive treatments (MWD pooled Mean Difference (MD) = 64.94 [10.77, 115.12] 95% CI, p = .02, 5 studies, and ABPI pooled MD = 0.15 [0.04, 0.26] 95% CI, p = .006, 5 studies). However, invasive interventions were associated with a higher rate of complications, including increased amputation risk (Pooled odds ratio (OR) = 2.46 [0.44, 13.94] 95% CI, p = .31, 3 studies), though this was not statistically significant. Long-term rates were higher in the Noninvasive treatment group (Pooled OR: 0.56 [0.33, 0.97] 95% CI, p = .04).

Conclusions

Both invasive and Noninvasive treatments are effective in managing IC. Invasive treatments provide greater improvement in blood flow and walking distance, but the risk of complications and re-interventions should be considered in treatment decisions. Further research with larger sample sizes and designed for long-term assessment is needed to assess the cost-effectiveness and long-term outcomes of invasive treatments.

Abstract Image

间歇性跛行有创与无创治疗的长期结果:系统回顾和荟萃分析
背景:间歇性跛行(IC)是外周动脉疾病(PAD)的标志性症状,在体力活动时由于下肢血流量减少而引起疼痛和不适。这种情况严重损害了受影响个体的活动能力和生活质量。IC的治疗选择范围从保守方法,包括最佳药物治疗(BMT)和监督运动治疗(SET),到侵入性干预,如血管成形术和开放血管重建。本荟萃分析和系统综述旨在评估非侵入性治疗对IC患者管理的长期结果。方法于2024年10月在PubMed, MEDLINE, Cochrane Library, Embase和Scopus数据库中进行了全面检索。随机对照试验(rct)比较侵入性干预和非侵入性治疗。主要结局为生活质量(QoL)、踝肱压力指数(ABPI)和最大步行距离(MWD)。次要结局是主要不良心血管事件(MACE)、死亡率、并发症和再干预率。使用Cochrane Review Manager 5进行数据分析。随访时间2 ~ 7年,最长随访时间2 ~ 7年;优先考虑2年的时间。结果共纳入11项rct, 1379例患者。有创治疗与无创治疗相比,MWD和ABPI有显著改善(MWD合并平均差值(MD) = 64.94 [10.77, 115.12] 95% CI, p =。22,5项研究,ABPI合并MD = 0.15 [0.04, 0.26] 95% CI, p =。006, 5项研究)。然而,侵入性干预与更高的并发症发生率相关,包括截肢风险增加(合并优势比(OR) = 2.46 [0.44, 13.94] 95% CI, p =。31,3项研究),尽管这在统计学上并不显著。无创治疗组的长期发生率较高(合并OR: 0.56 [0.33, 0.97] 95% CI, p = 0.04)。结论有创和无创治疗均可有效治疗IC。有创治疗可显著改善血流和步行距离,但在治疗决策时应考虑并发症和再次干预的风险。为了评估侵入性治疗的成本效益和长期结果,需要进一步研究更大的样本量并设计用于长期评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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