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Claudication often recurs after endovascular treatment without risk-factor management

Journal of Vascular Surgery
Reuters Health - 04/12/2020 - Most patients who undergo elective endovascular interventions for claudication are not medically optimized first, as recommended, and only a minority are free of symptoms at two years, according to a new study.

This study highlights "the importance of ensuring that patients who are being considered for endovascular procedures for claudication have undergone risk-factor modification including smoking cessation, exercise therapy and statin use. These are recommended guidelines for best practice before and after endovascular procedures," Dr. Jonathan Bath, director for vascular surgery at the University of Missouri, in Columbia, told Reuters Health by email.

"Endovascular procedures for claudication can have medium-term relief for patients with claudication; however, without appropriate risk-factor modification the patients are more likely to report repeat symptoms of claudication and undergo repeat procedures," he added.

Using data from the Vascular Quality Initiative, Dr. Bath and colleagues reviewed the outcomes of more than 16,000 patients (mean age, 66; 61% male) who underwent peripheral vascular intervention (PVI) for claudication.

Compliance with guidelines from the Society for Vascular Surgery (SVS) on optimal medical management was only "moderate," and symptom recurrence in the treated limb was "soberingly high," with 68% reporting ipsilateral recurrent claudication within two years of treatment.

These data are "cause for concern" given the rising number of interventions for claudication, the researchers write in the Journal of Vascular Surgery.

Of note, 45% of patients were active smokers at the time of the procedure and 28% were not prescribed an antiplatelet agents and statin medications at discharge, despite the well-recognized benefits of these agents.

Endovascular intervention for more than two arteries and use of atherectomy specifically were associated with a shorter time to symptom recurrence and shorter time to repeat procedure.

Discharge on an antiplatelet or statin was associated with a longer time to symptom recurrence and longer time to repeat intervention.

"Patients should be counseled that procedures for claudication are not a cure for the condition and that most patients will need close follow-up and may expect their symptoms to come back and possibly undergo repeat procedures," Dr. Bath told Reuters Health.

"Risk factor modification is an important part of the whole treatment algorithm that needs to be a shared commitment between both patient and clinicians in order to achieve the most durable results," he added.

SOURCE: https://bit.ly/3qqaE4n Journal of Vascular Surgery, online November 27, 2020.

By Megan Brooks

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