AHA 2015: PAD patients show improved walking after revascularization that precedes exercise

by Bruce Sylvester: Among patients with peripheral artery disease and intermittent claudication, treatment with endovascular revascularization followed by supervised exercise led to greater improvement in walking distances and health-related quality-of-life at one year than supervised exercise alone.

The findings were reported at the American Heart Association’s Scientific Sessions 2015 and were published simultaneously on November 10, 2015 in JAMA, the Journal of the American Medical Association.

“The present study reopens the debate for revascularization in patients with claudication, in particular in terms of an approach using endovascular revascularization first. By improving lower extremity blood flow, early percutaneous revascularization of the target lesion gives an impulse to patient mobility and quality of life in the short-term. This, in turn, facilitates subsequent exercising and allows the patient to profit from the long-term benefits of an additional supervised exercise program,” the authors said.

They noted that intermittent claudication in PAD affects approximately 20 to 40 million people worldwide and is growing among an aging world population.

M.G. Myriam Hunink, M.D., Ph.D., of the Erasmus University Medical Center, Rotterdam, the Netherlands, and colleagues enrolled subjects who had been diagnosed with PAD and intermittent claudication. They were randomized to endovascular revascularization plus supervised exercise (n = 106) or supervised exercise only (n = 106).

Primary endpoint was the difference in maximum treadmill walking distance between the groups at one year.

The investigators reported that combination treatment led to a significantly greater improvement in maximum walking distance when compared with supervised exercise only.

The same result was true for pain-free walking distance.

The combination therapy subjects also achieved significantly greater improvement in health-related quality-of-life.

Mary McGrae McDermott, M.D., of the Northwestern University Feinberg School of Medicine, Chicago, and Senior Editor of JAMA wrote in an accompanying editorial, “Randomized trial evidence already convincingly demonstrates that supervised treadmill exercise improves walking performance compared with no exercise. The ERASE trial newly demonstrates that supervised exercise also improves lower extremity outcomes after endovascular revascularization. Current reimbursement strategies in the United States provide significant incentives for clinicians to offer endovascular revascularizations to patients with peripheral artery disease, whereas supervised exercise remains expensive and inaccessible to patients. Reducing disability from peripheral artery disease in the 21st century requires strategies to ensure that effective exercise programs are accessible for all patients with peripheral artery disease.”