title: A systematic review of treatment of intermittent claudication in the lower extremities.
abstract: BACKGROUND
  Peripheral arterial disease is common and is associated with significant morbidity and mortality.
  
  
  METHODS
  We conducted a systematic review to identify randomized trials and systematic reviews of patients with intermittent claudication to evaluate surgery, endovascular therapy, and exercise therapy. Outcomes of interest were death, amputation, walking distance, quality of life, measures of blood flow, and cost.
  
  
  RESULTS
  We included eight systematic reviews and 12 trials enrolling 1548 patients. Data on mortality and amputation and on cost-effectiveness were sparse. Compared with medical management, each of the three treatments (surgery, endovascular therapy, and exercise therapy) was associated with improved walking distance, claudication symptoms, and quality of life (high-quality evidence). Evidence supporting superiority of one of the three approaches was limited. However, blood flow parameters improved faster and better with both forms of revascularization compared with exercise or medical management (low- to moderate-quality evidence). Compared with endovascular therapy, open surgery may be associated with longer length of hospital stay and higher complication rate but resulted in more durable patency (moderate-quality evidence).
  
  
  CONCLUSIONS
  In patients with claudication, open surgery, endovascular therapy, and exercise therapy were superior to medical management in terms of walking distance and claudication. Choice of therapy should rely on patients' values and preferences, clinical context, and availability of operative expertise.
authors.affiliation: Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn; Division of Vascular Surgery, University of Oklahoma, Tulsa, Okla.
authors.forename: Rafael D
authors.initials: RD
authors.lastname: Malgor
authors.affiliation: Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Fares
authors.initials: F
authors.lastname: Alahdab
authors.affiliation: Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Fares
authors.initials: F
authors.lastname: Alalahdab
authors.affiliation: Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Tarig A
authors.initials: TA
authors.lastname: Elraiyah
authors.affiliation: Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Vascular and Endovascular Surgery, Minneapolis, Minn.
authors.forename: Adnan Z
authors.initials: AZ
authors.lastname: Rizvi
authors.affiliation: Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Lane
authors.affiliation: Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Prokop
authors.affiliation: College of Pharmacy, Western University of Health Sciences, Pomona, Calif.
authors.forename: Olivia J
authors.initials: OJ
authors.lastname: Phung
authors.affiliation: Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Wigdan
authors.initials: W
authors.lastname: Farah
authors.affiliation: Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn; Division of Endocrinology, Mayo Clinic, Rochester, Minn.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.affiliation: Division of Vascular and Endovascular Surgery, University of California, San Francisco, Calif.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Conte
authors.affiliation: Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minn. Electronic address: murad.mohammad@mayo.edu.
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
mesh_terms: D000671:Amputation, Surgical; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D005081:Exercise Therapy / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D017079:Exercise Tolerance; D017048:Health Care Costs; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D007902:Length of Stay; D023821:Limb Salvage; D035002:Lower Extremity / Q000098:blood supply*; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011788:Quality of Life; D020127:Recovery of Function; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D016138:Walking
chemical_list: D002317:Cardiovascular Agents