Hageman David, van den Houten Marijn M, Spruijt Steffie, Gommans Lindy N, Scheltinga Marc R, Teijink Joep A
Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
J Cardiovasc Surg (Torino). 2017 Apr;58(2):305-312. doi: 10.23736/S0021-9509.16.09825-6. Epub 2016 Dec 19.
Intermittent claudication (IC) is a manifestation of peripheral arterial disease. IC has a high prevalence in the older population, is closely associated with other expressions of atherosclerotic disease and often co-exists in multimorbid patients. Treatment of IC should address reduction of cardiovascular risk and improvement of functional capacity and health-related quality of life (QoL). As recommended by contemporary international guidelines, the first-line treatment includes supervised exercise therapy (SET). In several randomized controlled trials and systematic reviews, SET is compared with usual care, placebo, walking advice and endovascular revascularization. The evidence supporting the efficacy of SET programs to alleviate claudication symptoms is robust. SET improves walking distance and health-related QoL and appears to be the most cost-effective treatment for IC. Nevertheless, only few of all newly diagnosed IC patients worldwide receive this safe, efficient and structured treatment. Worldwide implementation of structured SET programs is seriously impeded by outdated arguments favoring an invasive intervention, absence of a network of specialized physical therapists providing standardized SET and lack of awareness and/or knowledge of the importance of SET by referring physicians. Besides, misguiding financial incentives and lack of reimbursement hamper actual use of SET programs. In the Netherlands, a national integrated care network (ClaudicatioNet) was launched in 2011 to combat treatment shortcomings and stimulate cohesion and collaboration between stakeholders. This care intervention has resulted in optimized quality of care for all patients with IC.
间歇性跛行（IC）是外周动脉疾病的一种表现。IC在老年人群中患病率较高，与动脉粥样硬化疾病的其他表现密切相关，且常并存于多病共存的患者中。IC的治疗应着眼于降低心血管风险、改善功能能力以及提高与健康相关的生活质量（QoL）。根据当代国际指南的建议，一线治疗包括监督下的运动疗法（SET）。在多项随机对照试验和系统评价中，将SET与常规护理、安慰剂、步行建议和血管内血运重建进行了比较。支持SET方案缓解跛行症状疗效的证据确凿。SET可改善步行距离和与健康相关的QoL，似乎是治疗IC最具成本效益的方法。然而，在全球所有新诊断的IC患者中，只有少数人接受这种安全、有效且结构化的治疗。支持侵入性干预的过时观点、缺乏提供标准化SET的专业物理治疗师网络以及转诊医生对SET重要性的认识和/或知识不足，严重阻碍了结构化SET方案在全球的实施。此外，误导性的经济激励措施和报销不足也妨碍了SET方案的实际应用。在荷兰，2011年启动了一个全国性综合护理网络（ClaudicatioNet），以克服治疗缺陷并促进利益相关者之间的凝聚力与合作。这种护理干预已为所有IC患者优化了护理质量。
