Original title: Supervised Exercise, Stent Revascularization, or Medical Therapy for Claudication Due to Aortoiliac Peripheral Artery DiseaseThe CLEVER Study. Reference: J Am Coll Cardiol. 2015;65(10):999-1009.

Percutaneous revascularization has been effective to treat claudication due to aortoiliac peripheral artery disease. However, supervised exercise can also offer benefits in terms of functional class and quality of life, at least in the short term. Long term benefits of supervised exercise in aortoiliac disease have not been studied yet.

The aim of this study was to report the efficacy at short term (18 months) of supervised exercise vs. optimal medical care (OMC). It included 111 patients, randomized to OMC alone, PCI and OMC, or supervised exercise and OMT. Primary end point included an objective treadmill walking performance test and subjective quality of life assessment. 

Peak walking time improved both for the supervised exercise group (5.0 ± 5.4 min) and the percutaneous revascularization group (3.2 ± 4.7 min) resulting both significantly superior to OMC alone (0.2 ± 2.1 min; p < 0.001 y p = 0.04, respectively). The difference between supervised exercise and percutaneous revascularization was not significant (p = 0.16).

Improvement in claudication onset time was, as expected, greater for supervised exercise. Several quality scales showed durable improvements, especially with revascularization, compared to supervised exercise and OMC. 

Conclusion

In patients with aortoiliac disease, supervised exercise and percutaneous revascularization showed comparable and durable benefits, both strategies being superior to OMC alone.

Editorial Comment

Percutaneous revascularization has an advantage, because patients improve immediately after procedure and do not need to make an effort to overcome symptoms to keep walking. This may seem unimportant, but it had great impact in all quality of life assessment questionnaires. 

SOLACI