Intermittent Claudication: Invasive Treatment Superior to Pharmacological Treatment?

Peripheral vascular disease is strongly associated to cardiovascular events and a negative impact on health status and quality of life.

Claudicación Intermitente: ¿el tratamiento invasivo es superior al tratamiento farmacológico?

However, researchers are yet to determine the benefit of early intervention in patients presenting intermittent claudication, and whether it improves quality of life.

At present, there is little information in this regard (CLEVER trial), and it remains unclear when is best to intervene.

The PORTRAIT is an international prospective multicenter study including 1246 patients with intermittent claudication, 314 receiving early invasive treatment -PCI or surgery plus 3-month medical treatment after diagnosis vs. medical treatment alone.

Health status and quality of life were assessed by the Peripheral Artery Questionnaire (PAQ).

Mean age was 67. There were no differences in diabetes, hypertension, dyslipidemia, prior MI, stroke, CAD or cardiac failure. Neither were there differences as regards disease localization. CAD was more severe in patients undergoing early intervention (46% Ruherford III in the early intervention group vs. 21.9% in the medical treatment group).

At one-year followup, PAQ was superior in patients undergoing early invasive treatment vs patients receiving medical treatment alone.

After propensity score matching, 297 patients were left to receive early invasive treatment vs. 703 who received medical treatment alone.

After 12 months, PAQ improvement was maintained in patients undergoing early intervention 30.8±25.2 vs. 16.7±23.4 (p<0.001)

Conclusion

Patients with intermittent claudication undergoing early invasive intervention saw significant improved health status at one year compared against patients receiving a non-invasive treatment. This information might facilitate decision making when treating these patients.