Choosing Wisely:

Don’t use interventions (including surgical bypass, angiogram, angioplasty or stent) as a first line of treatment for most patients with intermittent claudication.

Rationale and Comments: A trial of smoking cessation, risk factor modification, diet and exercise, as well as pharmacologic treatment should be attempted before any procedures. When indicated, the type of intervention (surgery or angioplasty) depends on several factors. Intermittent claudication can vary due to several factors. The lifetime incidence of amputation in a patient with claudication is less than 5% with appropriate risk factor modification. Procedures for claudication are usually not limb-saving, but, rather, lifestyle-improving. However, interventions are not without risks, including worsening the patient’s perfusion, and should be reserved until a trial of conservative management has been attempted. Many people will actually realize an increase in their walking distance and pain threshold with exercise therapy. In cases in which the claudication limits a person’s ability to carry out normal daily functions, it is appropriate to intervene. Depending on the characteristics of the occlusive process, and patient comorbidities, the best option for treatment may be either surgical or endovascular.
Sponsoring Organizations:
  • Society for Vascular Surgery
  • Sources:
  • Expert consensus
  • Disciplines:
  • Cardiovascular
  • Surgical
  • References: • Adam DJ, Beard JD, Cleveland T, Bell J, Bradbury AW, Forbes JF, Fowkes FG, Gillepsie I, Ruckley CV, Raab G, Storkey H; BASIL trial participants. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005;366(9501):1925-34.
    • Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG; TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45 Suppl S:S5-67.

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