Conte Michael S, Aulivola Bernadette, Barshes Neal R, Bertges Daniel J, Corriere Matthew A, Murad M Hassan, Powell Richard J, Reed Amy B, Robinson William P, Simons Jessica P
Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, CA.
Division of Vascular Surgery and Endovascular Therapy, Loyola University Chicago Stritch School of Medicine, Maywood, IL.
J Vasc Surg. 2025 Aug;82(2):303-326.e11. doi: 10.1016/j.jvs.2025.04.041. Epub 2025 Apr 30.
Intermittent claudication (IC) is the most common symptom of peripheral artery disease, which is a growing public health burden in the United States and globally. Patients with IC present with a broad spectrum of risk factors, comorbid conditions, range of disability, and treatment goals. Informed shared decision-making hinges on a comprehensive evaluation of these factors, patient education, and knowledge of the latest available evidence. In 2015, the Society for Vascular Surgery published a clinical practice guideline on the management of asymptomatic peripheral artery disease and IC. An expert writing group was commissioned to provide a focused update to this guideline on the management of IC. Based on the available evidence from published research conducted since the prior guideline, six specific key questions were formulated spanning the areas of antithrombotic management, exercise therapy, and revascularization for IC. A systematic review and evidence synthesis of each question was conducted by a dedicated methodology team. The GRADE approach was employed to describe the strength of each recommendation and level of certainty of evidence. The review identified major gaps in evidence particularly in the arena of comparative effectiveness for interventions (exercise, revascularization) across defined clinical subgroups and employing meaningful patient-centered outcomes. Twelve recommendations, among which are two best practice statements, are provided in this focused update. They address the use of dual pathway antithrombotic strategies, the role and type of exercise therapy, endovascular interventions for femoropopliteal and infrapopliteal disease, and the identification of specific risk factors that should be incorporated into shared decision-making around revascularization. A comprehensive and individualized approach to the management of patients with IC, relying first on education, risk factor control, optimal medical therapy, and exercise, is emphasized. A rubric for decision-making that includes a thorough assessment of risk, benefits, degree of impairment, and treatment durability, is considered fundamental to a patient-centered approach in IC. Significant unmet research needs in this field are also enumerated.
间歇性跛行（IC）是外周动脉疾病最常见的症状，在美国乃至全球，外周动脉疾病作为一个公共卫生问题，其负担正日益加重。患有IC的患者存在广泛的风险因素、合并症、残疾程度及治疗目标。明智的共同决策取决于对这些因素的全面评估、患者教育以及对最新可得证据的了解。2015年，血管外科学会发布了关于无症状外周动脉疾病和IC管理的临床实践指南。一个专家写作小组受委托对该IC管理指南进行重点更新。基于自先前指南发布以来已发表研究的现有证据，制定了六个特定的关键问题，涵盖抗血栓管理、运动疗法以及IC血运重建等领域。一个专门的方法学团队对每个问题进行了系统评价和证据综合。采用GRADE方法来描述每条推荐意见的强度和证据的确定性水平。该评价发现证据存在重大空白，尤其是在跨特定临床亚组的干预措施（运动、血运重建）的比较有效性以及采用有意义的以患者为中心的结局方面。本次重点更新提供了12条推荐意见，其中包括两条最佳实践声明。这些推荐意见涉及双途径抗血栓策略的使用、运动疗法的作用和类型、股腘动脉和腘下动脉疾病的血管内介入治疗，以及在血运重建共同决策中应纳入的特定风险因素的识别。强调对IC患者管理应采取全面且个体化的方法，首先依靠教育、风险因素控制、优化药物治疗和运动。一种决策准则，包括对风险、益处、损伤程度和治疗持久性的全面评估被认为是IC以患者为中心方法的基础。该领域重大未满足的研究需求也被列举出来。
