Nav: Home

Effectiveness of medical management vs revascularization for intermittent leg claudication

August 17, 2016

Among patients with intermittent claudication, those who had revascularization had significantly improved walking function, better health-related quality of life, and fewer symptoms of claudication at 12 months compared with those who had medical management (walking program, smoking cessation counseling, and medications), according to a study published online by JAMA Surgery.

Atherosclerotic peripheral arterial disease (PAD) affects 8 million Americans. Intermittent claudication (IC), a symptom of PAD, manifests as pain in the calf or foot with walking and is present in more than 8 million people worldwide. Both medical and revascularization interventions for IC aim to increase walking comfort and distance, but there is inconclusive evidence of the comparative benefit of revascularization given the possible risk of limb loss.

Emily B. Devine, Ph.D., Pharm.D., M.B.A., of the University of Washington, Seattle, and colleagues compared the effectiveness of a medical (walking program, smoking cessation counseling, and medications) vs revascularization (endovascular or surgical) intervention for IC, focusing on outcomes of greatest importance to patients. The study was conducted at 15 clinics associated with 11 hospitals in Washington State. Participants were 21 years or older with newly diagnosed or established IC.

A total of 323 adults were enrolled, with 282 (87 percent) in the medical cohort. At study entry, the average duration of disease was longer for participants in the medical cohort, while those in the revascularization cohort reported more severe disease. At 12 months, change in scores of various measures in the medical cohort reached significance for the following 3 outcomes: speed, Vascular Quality of Life Questionnaire (VascuQol; measures the effect of PAD across 5 domains), and European Quality of Life-5 Dimension Questionnaire (EQ-50; assessment that quantifies overall health). In the revascularization cohort, there were significant improvements in the following 7 outcomes: distance, speed, stair climb, pain, VascuQol, EQ-50, and Claudication Symptom Instrument (CSI; assesses claudication symptoms in the leg or foot).

Relative improvements (percentage changes) at 12 months in the revascularization cohort over the medical cohort were observed as follows: distance (39 percent), speed (16 percent), stair climb (10 percent), pain (117 percent),VascuQol (41 percent), EQ-50 (18 percent), and CSI (14 percent).

"This comparative effectiveness research study of interventions for IC demonstrated significantly higher function, better HRQoL, and fewer symptoms for those in the revascularization cohort compared with the medical cohort. These results suggest that revascularization interventions for patients with moderate to severe IC represent a reasonable alternative to medical management, providing important information to inform treatment strategies in the community," the authors write.
-end-
(JAMA Surgery. Published online August 17, 2016. doi:10.1001/jamasurg.2016.2024. This study is available pre-embargo at the For The Media website.)

Editor's Note: This work was funded by a grant from the Agency for Healthcare Research and Quality. No conflict of interest disclosures were reported.

Note: Available pre-embargo at the For The Media website is an accompanying commentary, "Decisive Steps Toward Patient-Reported Outcomes for Claudication--Tread Lightly or Full Steam Ahead?" by Philip P. Goodney, M.D., M.S., of the Dartmouth-Hitchcock Medical Center, Lebanon, N.H., and Matthew A. Corriere, M.D., M.S., of Wake Forest University, Winston-Salem, N.C.

Media Advisory: To contact Emily B. Devine, Ph.D., Pharm.D., M.B.A., call Sarah Guthrie at 206-543-3485 or email gu3@uw.edu.

The JAMA Network Journals

Related Pain Articles:

Pain researchers get a common language to describe pain
Pain researchers around the world have agreed to classify pain in the mouth, jaw and face according to the same system.
It's not just a pain in the head -- facial pain can be a symptom of headaches too
A new study finds that up to 10% of people with headaches also have facial pain.
New opioid speeds up recovery without increasing pain sensitivity or risk of chronic pain
A new type of non-addictive opioid developed by researchers at Tulane University and the Southeast Louisiana Veterans Health Care System accelerates recovery time from pain compared to morphine without increasing pain sensitivity, according to a new study published in the Journal of Neuroinflammation.
The insular cortex processes pain and drives learning from pain
Neuroscientists at EPFL have discovered an area of the brain, the insular cortex, that processes painful experiences and thereby drives learning from aversive events.
Pain, pain go away: new tools improve students' experience of school-based vaccines
Researchers at the University of Toronto and The Hospital for Sick Children (SickKids) have teamed up with educators, public health practitioners and grade seven students in Ontario to develop and implement a new approach to delivering school-based vaccines that improves student experience.
Pain sensitization increases risk of persistent knee pain
Becoming more sensitive to pain, or pain sensitization, is an important risk factor for developing persistent knee pain in osteoarthritis (OA), according to a new study by researchers from the Université de Montréal (UdeM) School of Rehabilitation and Hôpital Maisonneuve Rosemont Research Centre (CRHMR) in collaboration with researchers at Boston University School of Medicine (BUSM).
Becoming more sensitive to pain increases the risk of knee pain not going away
A new study by researchers in Montreal and Boston looks at the role that pain plays in osteoarthritis, a disease that affects over 300 million adults worldwide.
Pain disruption therapy treats source of chronic back pain
People with treatment-resistant back pain may get significant and lasting relief with dorsal root ganglion (DRG) stimulation therapy, an innovative treatment that short-circuits pain, suggests a study presented at the ANESTHESIOLOGY® 2018 annual meeting.
Sugar pills relieve pain for chronic pain patients
Someday doctors may prescribe sugar pills for certain chronic pain patients based on their brain anatomy and psychology.
Peripheral nerve block provides some with long-lasting pain relief for severe facial pain
A new study has shown that use of peripheral nerve blocks in the treatment of Trigeminal Neuralgia (TGN) may produce long-term pain relief.
More Pain News and Pain Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: Reinvention
Change is hard, but it's also an opportunity to discover and reimagine what you thought you knew. From our economy, to music, to even ourselves–this hour TED speakers explore the power of reinvention. Guests include OK Go lead singer Damian Kulash Jr., former college gymnastics coach Valorie Kondos Field, Stockton Mayor Michael Tubbs, and entrepreneur Nick Hanauer.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Dispatch 6: Strange Times
Covid has disrupted the most basic routines of our days and nights. But in the middle of a conversation about how to fight the virus, we find a place impervious to the stalled plans and frenetic demands of the outside world. It's a very different kind of front line, where urgent work means moving slow, and time is marked out in tiny pre-planned steps. Then, on a walk through the woods, we consider how the tempo of our lives affects our minds and discover how the beats of biology shape our bodies. This episode was produced with help from Molly Webster and Tracie Hunte. Support Radiolab today at Radiolab.org/donate.