title: Long-term clinical effectiveness of supervised exercise therapy versus endovascular revascularization for intermittent claudication from a randomized clinical trial.
abstract: BACKGROUND
  Long-term comparisons of supervised exercise therapy (SET) and endovascular revascularization (ER) for patients with intermittent claudication are scarce. The long-term clinical effectiveness of SET and ER was assessed in patients from a randomized trial.
  
  
  METHODS
  Consenting patients with intermittent claudication were assigned randomly to either SET or ER. Outcome measures on functional performance (pain-free and maximum walking distance, ankle : brachial pressure index), quality of life (QoL) and number of secondary interventions were measured at baseline and after approximately 7 years of follow-up. Repeated-measurement and Kaplan-Meier methods were used to analyse the data on an intention-to treat-basis.
  
  
  RESULTS
  A total of 151 patients were randomized initially to either SET or ER. After 7 years, functional performance (P < 0.001) and QoL (P ≤ 0.005) had improved after both SET and ER. Long-term comparison showed no differences between the two treatments, except in the secondary intervention rate, which was significantly higher after SET (P = 0.001). Nevertheless, the total number of endovascular and surgical interventions (primary and secondary) remained higher after ER (P < 0.001).
  
  
  CONCLUSIONS
  In the longer term, SET-first or ER-first treatment strategies were equally effective in improving functional performance and QoL in patients with intermittent claudication. The substantially higher number of invasive interventions in the ER-first group supports a SET-first treatment strategy for intermittent claudication.
  
  
  BACKGROUND
  NTR199 (http://www.trialregister.nl).
authors.affiliation: Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands. f.fakhry@erasmusmc.nl
authors.forename: F
authors.initials: F
authors.lastname: Fakhry
authors.forename: E V
authors.initials: EV
authors.lastname: Rouwet
authors.forename: P T
authors.initials: PT
authors.lastname: den Hoed
authors.forename: M G M
authors.initials: MG
authors.lastname: Hunink
authors.forename: S
authors.initials: S
authors.lastname: Spronk
mesh_terms: D000800:Angioplasty, Balloon / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D063427:Food Quality; D006801:Humans; D007383:Intermittent Claudication / Q000503:physiopathology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D015424:Reperfusion / Q000379:methods; D015607:Stents; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology