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Combination of endovascular revascularization and supervised exercise therapy for intermittent claudication: a systematic review and meta-analysis.
J Cardiovasc Surg (Torino). 2018 Apr; 59(2):150-157.JC

Abstract

BACKGROUND

Peripheral arterial disease is a major health concern in the Western world, often treated with endovascular revascularization (EVR) or supervised exercise therapy (SET). In this systematic review and meta-analysis, we assessed the outcomes after combination treatment of EVR and SET, compared with EVR or SET alone.

EVIDENCE ACQUISITION

We performed a systematic search of Embase, Medline, Web of Science, Cochrane Central and Google Scholar. Only randomized controlled trials comparing combination treatment with EVR or SET only, for patients with intermittent claudication due to femoropopliteal or aortoiliac peripheral artery disease, were included. Primary outcome was maximum walking distance (MWD) at 6 and 12 months' follow-up. Secondary outcomes included pain-free walking distance (PFWD), quality of life and adverse events. Pooled estimates of difference in walking distance between EVR plus SET, EVR only and SET only were calculated using random effects models.

EVIDENCE SYNTHESIS

Our search yielded 812 articles, of which 7 were finally included in the systematic review. Three studies reported the outcomes of combination treatment versus SET and three more reported the outcomes of combination versus EVR. Follow-up ranged between 6 and 24 months. Combination treatment was associated with a greater MWD at 6 months compared to EVR only or SET only, with a standardized mean difference (SMD) of 0.86 (95% CI: 0.15, 1.57) and 0.41 (95% CI: 0.17, 0.66), respectively. At twelve months no significant difference in maximum walking distance was observed between combination treatment compared to EVR (SMD 0.96 [95% CI: -0.44, 2.37]) or SET (SMD 0.52 [95% CI: -0.17, 1.20]). Compared to EVR only, the combination treatment was associated with a greater PFWD walking distance at 12 months (SMD 0.73 [95% CI 0.01, 1.45]). Most studies reported only minor differences in quality of life in favor of the combination treatment, or no difference at all.

CONCLUSIONS

Combination treatment of endovascular revascularization followed by SET shows a greater improvement in maximum walking distance at 6 months' follow-up compared to EVR only or SET only, while this difference was no longer present after 12 months.

Authors+Show Affiliations

Department of Vascular Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands - s.klaphake@erasmusmc.nl.Department of Vascular Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.Department of Vascular Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.Department of Vascular Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.Department of Anesthesiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.Department of Vascular Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

29327569

Citation

Klaphake, Sanne, et al. "Combination of Endovascular Revascularization and Supervised Exercise Therapy for Intermittent Claudication: a Systematic Review and Meta-analysis." The Journal of Cardiovascular Surgery, vol. 59, no. 2, 2018, pp. 150-157.
Klaphake S, Buettner S, Ultee KH, et al. Combination of endovascular revascularization and supervised exercise therapy for intermittent claudication: a systematic review and meta-analysis. J Cardiovasc Surg (Torino). 2018;59(2):150-157.
Klaphake, S., Buettner, S., Ultee, K. H., van Rijn, M. J., Hoeks, S. E., & Verhagen, H. J. (2018). Combination of endovascular revascularization and supervised exercise therapy for intermittent claudication: a systematic review and meta-analysis. The Journal of Cardiovascular Surgery, 59(2), 150-157. https://doi.org/10.23736/S0021-9509.18.10346-6
Klaphake S, et al. Combination of Endovascular Revascularization and Supervised Exercise Therapy for Intermittent Claudication: a Systematic Review and Meta-analysis. J Cardiovasc Surg (Torino). 2018;59(2):150-157. PubMed PMID: 29327569.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combination of endovascular revascularization and supervised exercise therapy for intermittent claudication: a systematic review and meta-analysis. AU - Klaphake,Sanne, AU - Buettner,Stefan, AU - Ultee,Klaas H, AU - van Rijn,Marie J, AU - Hoeks,Sanne E, AU - Verhagen,Hence J, Y1 - 2018/01/09/ PY - 2018/1/13/pubmed PY - 2018/4/3/medline PY - 2018/1/13/entrez SP - 150 EP - 157 JF - The Journal of cardiovascular surgery JO - J Cardiovasc Surg (Torino) VL - 59 IS - 2 N2 - BACKGROUND: Peripheral arterial disease is a major health concern in the Western world, often treated with endovascular revascularization (EVR) or supervised exercise therapy (SET). In this systematic review and meta-analysis, we assessed the outcomes after combination treatment of EVR and SET, compared with EVR or SET alone. EVIDENCE ACQUISITION: We performed a systematic search of Embase, Medline, Web of Science, Cochrane Central and Google Scholar. Only randomized controlled trials comparing combination treatment with EVR or SET only, for patients with intermittent claudication due to femoropopliteal or aortoiliac peripheral artery disease, were included. Primary outcome was maximum walking distance (MWD) at 6 and 12 months' follow-up. Secondary outcomes included pain-free walking distance (PFWD), quality of life and adverse events. Pooled estimates of difference in walking distance between EVR plus SET, EVR only and SET only were calculated using random effects models. EVIDENCE SYNTHESIS: Our search yielded 812 articles, of which 7 were finally included in the systematic review. Three studies reported the outcomes of combination treatment versus SET and three more reported the outcomes of combination versus EVR. Follow-up ranged between 6 and 24 months. Combination treatment was associated with a greater MWD at 6 months compared to EVR only or SET only, with a standardized mean difference (SMD) of 0.86 (95% CI: 0.15, 1.57) and 0.41 (95% CI: 0.17, 0.66), respectively. At twelve months no significant difference in maximum walking distance was observed between combination treatment compared to EVR (SMD 0.96 [95% CI: -0.44, 2.37]) or SET (SMD 0.52 [95% CI: -0.17, 1.20]). Compared to EVR only, the combination treatment was associated with a greater PFWD walking distance at 12 months (SMD 0.73 [95% CI 0.01, 1.45]). Most studies reported only minor differences in quality of life in favor of the combination treatment, or no difference at all. CONCLUSIONS: Combination treatment of endovascular revascularization followed by SET shows a greater improvement in maximum walking distance at 6 months' follow-up compared to EVR only or SET only, while this difference was no longer present after 12 months. SN - 1827-191X UR - https://www.unboundmedicine.com/medline/citation/29327569/Combination_of_endovascular_revascularization_and_supervised_exercise_therapy_for_intermittent_claudication:_a_systematic_review_and_meta_analysis_ L2 - https://www.minervamedica.it/index2.t?show=R37Y2018N02A0150 DB - PRIME DP - Unbound Medicine ER -