A Systematic Review of Extracorporeal Shockwave Therapy as a Novel Treatment for Intermittent Claudication.
BACKGROUND
Extracorporeal shockwave therapy (ESWT) is emerging as a potential new treatment option for a variety of clinical scenarios including promotion of wound healing and symptom control in end-stage ischemic heart disease. A number of small trials have investigated ESWT in the management of peripheral arterial disease (PAD). A systematic review of the literature was performed investigating the efficacy and potential mechanism of action of ESWT for PAD.


METHODS
A systematic review was conducted using MEDLINE and PubMed databases in keeping with the standard reporting guidelines set by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis group to identify any publications relating to the use of ESWT in PAD.


RESULTS
Systematic literature review identified 5 studies in 4 articles investigating ESWT in the treatment of symptomatic PAD. Although participant numbers within the identified studies were small, significant improvements in pain-free walking distance and maximum walking distance were demonstrated. The mechanism of action is thought to be due to mechanotransduction and subsequent angiogenesis.


CONCLUSIONS
ESWT shows promise as a potentially efficacious novel treatment for symptomatic PAD. However, studies to date are small and record heterogeneous outcomes. Appropriately powered, randomized, sham-controlled data including objective clinical outcomes to comprehensively assess the efficacy of this novel treatment modality is still required before determining if ESWT should be brought into routine clinical practice.
Academic Vascular Surgery Unit, University of Hull, Hull York Medical School, Hull, UK. Electronic address: thomascayton@hotmail.com.
Thomas
T
Cayton
Academic Vascular Surgery Unit, University of Hull, Hull York Medical School, Hull, UK.
Amy
A
Harwood
Academic Vascular Surgery Unit, University of Hull, Hull York Medical School, Hull, UK.
George E
GE
Smith
Academic Vascular Surgery Unit, University of Hull, Hull York Medical School, Hull, UK.
Ian
I
Chetter
D017079:Exercise Tolerance; D019220:High-Energy Shock Waves / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D017060:Patient Satisfaction; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011788:Quality of Life; D020127:Recovery of Function; D012720:Severity of Illness Index; D016896:Treatment Outcome; D016138:Walking