Saadi Samer, Nayfeh Tarek, Rajjoub Rami, Hasan Bashar, Firwana Mohammed, Jawaid Tabinda, Hazem Walid, Shah Sahrish, Alsawaf Yahya, Seisa Mohamed O, Prokop Larry J, Conte Michael S, Murad M Hassan
Evidence-Based Practice Center, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
Evidence-Based Practice Center, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
J Vasc Surg. 2025 Aug;82(2):688-697. doi: 10.1016/j.jvs.2024.12.135. Epub 2025 Apr 30.
This systematic review and meta-analysis evaluates the current evidence on the management of intermittent claudication (IC), a prevalent manifestation of peripheral arterial disease (PAD).
We conducted comprehensive searches of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus. We addressed six questions developed by a guideline committee from the Society for Vascular Surgery, addressing pharmacological treatments, exercise regimens, endovascular interventions, and predictors of major adverse cardiovascular, limb-related events, and mortality.
The search resulted in 5333 citations, from which we included 73 studies (46 randomized trials). In patients with PAD and IC who had one or more high-risk comorbidities, low-dose rivaroxaban and aspirin were associated with lower risk of major adverse limb events and major adverse cardiovascular events than aspirin alone. In patients who have undergone surgical or endovascular interventions for PAD, the addition of low-dose rivaroxaban to aspirin may improve limb outcomes. Of note, rivaroxaban trials excluded patients at high risk of bleeding. Single antiplatelet agents showed no significant efficacy differences head-to-head in ambulatory patients with IC and had a lower bleeding risk compared with combination therapy or anticoagulation. Home exercise programs were feasible and may be an alternative to supervised exercise in ambulatory patients with IC and in those who had revascularization. Several comorbidities increased the risk of adverse outcomes after revascularization for IC, such as advanced age, diabetes, coronary artery disease, chronic obstructive pulmonary disease, previous interventions, congestive heart failure, infrapopliteal artery involvement, and longer lesion lengths. In patients with IC undergoing endovascular intervention for superficial femoral artery disease, plain balloon angioplasty was associated with worse outcomes than drug elution or stent implantation for intermediate or longer lesions (ie, >5 cm).
This systematic review summarizes the current evidence base for the management of IC, offering insights into the relative benefits and risks of various therapeutic strategies. The findings underscore the need for individualized patient care, considering both the potential benefits and risks associated with different interventions.
本系统评价和荟萃分析评估了关于间歇性跛行（IC）管理的现有证据，IC是外周动脉疾病（PAD）的一种常见表现。
我们对MEDLINE、EMBASE、Cochrane对照试验中心注册库、Cochrane系统评价数据库和Scopus进行了全面检索。我们回答了血管外科学会指南委员会提出的六个问题，涉及药物治疗、运动方案、血管内介入治疗以及主要不良心血管、肢体相关事件和死亡率的预测因素。
检索得到5333条引文，从中纳入了73项研究（46项随机试验）。在患有一种或多种高危合并症的PAD和IC患者中，与单独使用阿司匹林相比，低剂量利伐沙班和阿司匹林联合使用与较低的主要不良肢体事件和主要不良心血管事件风险相关。在接受过PAD手术或血管内介入治疗的患者中，在阿司匹林基础上加用低剂量利伐沙班可能改善肢体预后。值得注意的是，利伐沙班试验排除了出血高危患者。在IC门诊患者中，单一抗血小板药物在疗效上没有显著的直接差异，并且与联合治疗或抗凝相比出血风险更低。家庭锻炼计划是可行的，对于IC门诊患者以及接受过血运重建的患者，可能是监督锻炼的替代方案。几种合并症会增加IC血运重建后不良结局的风险，如高龄、糖尿病、冠状动脉疾病、慢性阻塞性肺疾病、既往干预、充血性心力衰竭、腘下动脉受累以及病变长度较长。在因股浅动脉疾病接受血管内介入治疗的IC患者中，对于中等长度或更长病变（即>5 cm），单纯球囊血管成形术的结局比药物洗脱或支架植入术更差。
本系统评价总结了IC管理的当前证据基础，深入了解了各种治疗策略的相对益处和风险。研究结果强调了个体化患者护理的必要性，要同时考虑不同干预措施的潜在益处和风险。
