Intermittent claudication: clinical effectiveness of endovascular revascularization versus supervised hospital-based exercise training--randomized controlled trial. Export

@article{citeulike:4166451, abstract = {PURPOSE: To compare clinical success, functional capacity, and quality of life during 12 months after revascularization or supervised exercise training in patients with intermittent claudication. MATERIALS AND METHODS: This study had institutional review board approval, and all patients gave written informed consent. Between September 2002 and September 2005, 151 consecutive patients who presented with symptoms of intermittent claudication were randomly assigned to undergo either endovascular revascularization (angioplasty-first approach) (n = 76) or hospital-based supervised exercise (n = 75). The outcome measures were clinical success, functional capacity, and quality of life after 6 and 12 months. Clinical success was defined as improvement in at least one category in the Rutherford scale above the pretreatment level. Significance of differences between the groups was assessed with the unpaired t test, chi(2) test, or Mann-Whitney U test. To adjust outcomes for imbalances of baseline values, multivariable regression analysis was performed. RESULTS: Immediately after the start of treatment, patients who underwent revascularization improved more than patients who performed exercise in terms of clinical success (adjusted odds ratio [OR], 39; 99\% confidence interval [CI]: 11, 131; P < .001), but this advantage was lost after 6 (adjusted OR, 0.9; 99\% CI: 0.3, 2.3; P = .70) and 12 (adjusted OR, 1.1; 99\% CI: 0.5, 2.8; P = .73) months. After revascularization, fewer patients showed signs of ipsilateral symptoms at 6 months compared with patients in the exercise group (adjusted OR, 0.4; 99\% CI: 0.2, 0.9; P < .001), but no significant differences were demonstrated at 12 months. After both treatments, functional capacity and quality of life scores increased after 6 and 12 months, but no significant differences between the groups were demonstrated. CONCLUSION: After 6 and 12 months, patients with intermittent claudication benefited equally from either endovascular revascularization or supervised exercise. Improvement was, however, more immediate after revascularization.}, author = {Spronk, S. and Bosch, J. L. and den Hoed, P. T. and Veen, H. F. and Pattynama, P. M. and Hunink, M. G.}, citeulike-article-id = {4166451}, citeulike-linkout-0 = {http://dx.doi.org/10.1148/radiol.2501080607}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/19188327}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=19188327}, comment = {No. 09-0219-02 間欠性跛行の治療：運動対血行再建術 Exercise vs. Revascularization for Intermittent Claudication 2009 February 19 運動トレーニングおよび血管内血行再建術は、いずれも血管性間欠性跛行を有する患者の治療選択肢である。オランダから報告されたこの試験では、間欠性跛行患者150人が、指導下の運動トレーニングを受ける群と、大腿動脈狭窄または腸骨動脈狭窄に対する血管形成術（一部の患者でステント留置が施術された）を受ける群のいずれかにランダムに割り付けられた。運動群の患者は24週間にわたって週に2回、指導下のプログラムに参加し、家庭での歩行プログラムの指導を受けた。血行再建群の患者は、全般的な生活習慣のアドバイスを受けた。 ベースラインにおいて、安静時足関節上腕血圧比（ankle-brachial index：ABI）の平均値は0.62であり、最大無痛歩行距離の平均値は約90m、最大歩行距離の平均値は約180mであった。血行再建群の患者は、試験開始後の1週間では、運動群の患者よりも大幅に急速な改善を示した。しかし、6ヵ月および12ヵ月の時点における最大歩行距離およびQOL（quality-of-life）スコアの改善は、両群で同様であった。運動群の患者で、1年間のフォローアップ期間中に血行再建術にクロスオーバーした患者はわずか11％であった。 コメント：間欠性跛行患者において、血行再建術の方が運動トレーニングよりも速やかな改善をもたらすことは、驚くにあたらない。しかし、運動群は数ヵ月以内に同じレベルに「追いつく」。血行再建術では合併症が発生しうること、運動は幅広い利益をもたらすことから、この試験は、間欠性跛行の治療の最初のアプローチとして体系的な運動を実施する根拠を補強するものである。 — Allan S. Brett, MD Published in Journal Watch General Medicine February 19, 2009 Citation(s): Spronk S et al. Intermittent claudication: Clinical effectiveness of endovascular revascularization versus supervised hospital-based exercise training — Randomized controlled trial. Radiology 2009 Feb; 250:586. Original article (Subscription may be required) Medline abstract (Free)}, doi = {10.1148/radiol.2501080607}, issn = {1527-1315}, journal = {Radiology}, keywords = {intermittentclaudication}, month = {February}, number = {2}, pages = {586--595}, posted-at = {2009-03-11 22:38:23}, priority = {2}, title = {Intermittent claudication: clinical effectiveness of endovascular revascularization versus supervised hospital-based exercise training--randomized controlled trial.}, url = {http://dx.doi.org/10.1148/radiol.2501080607}, volume = {250}, year = {2009} }

TY - JOUR ID - citeulike:4166451 L3 - citeulike-article-id:4166451 N2 - PURPOSE: To compare clinical success, functional capacity, and quality of life during 12 months after revascularization or supervised exercise training in patients with intermittent claudication. MATERIALS AND METHODS: This study had institutional review board approval, and all patients gave written informed consent. Between September 2002 and September 2005, 151 consecutive patients who presented with symptoms of intermittent claudication were randomly assigned to undergo either endovascular revascularization (angioplasty-first approach) (n = 76) or hospital-based supervised exercise (n = 75). The outcome measures were clinical success, functional capacity, and quality of life after 6 and 12 months. Clinical success was defined as improvement in at least one category in the Rutherford scale above the pretreatment level. Significance of differences between the groups was assessed with the unpaired t test, chi(2) test, or Mann-Whitney U test. To adjust outcomes for imbalances of baseline values, multivariable regression analysis was performed. RESULTS: Immediately after the start of treatment, patients who underwent revascularization improved more than patients who performed exercise in terms of clinical success (adjusted odds ratio [OR], 39; 99% confidence interval [CI]: 11, 131; P < .001), but this advantage was lost after 6 (adjusted OR, 0.9; 99% CI: 0.3, 2.3; P = .70) and 12 (adjusted OR, 1.1; 99% CI: 0.5, 2.8; P = .73) months. After revascularization, fewer patients showed signs of ipsilateral symptoms at 6 months compared with patients in the exercise group (adjusted OR, 0.4; 99% CI: 0.2, 0.9; P < .001), but no significant differences were demonstrated at 12 months. After both treatments, functional capacity and quality of life scores increased after 6 and 12 months, but no significant differences between the groups were demonstrated. CONCLUSION: After 6 and 12 months, patients with intermittent claudication benefited equally from either endovascular revascularization or supervised exercise. Improvement was, however, more immediate after revascularization. IS - 2 JF - Radiology SN - 1527-1315 EP - 595 TI - Intermittent claudication: clinical effectiveness of endovascular revascularization versus supervised hospital-based exercise training--randomized controlled trial. VL - 250 SP - 586 KW - intermittentclaudication N1 - No. 09-0219-02 間欠性跛行の治療：運動対血行再建術 Exercise vs. Revascularization for Intermittent Claudication 2009 February 19 運動トレーニングおよび血管内血行再建術は、いずれも血管性間欠性跛行を有する患者の治療選択肢である。オランダから報告されたこの試験では、間欠性跛行患者150人が、指導下の運動トレーニングを受ける群と、大腿動脈狭窄または腸骨動脈狭窄に対する血管形成術（一部の患者でステント留置が施術された）を受ける群のいずれかにランダムに割り付けられた。運動群の患者は24週間にわたって週に2回、指導下のプログラムに参加し、家庭での歩行プログラムの指導を受けた。血行再建群の患者は、全般的な生活習慣のアドバイスを受けた。 ベースラインにおいて、安静時足関節上腕血圧比（ankle-brachial index：ABI）の平均値は0.62であり、最大無痛歩行距離の平均値は約90m、最大歩行距離の平均値は約180mであった。血行再建群の患者は、試験開始後の1週間では、運動群の患者よりも大幅に急速な改善を示した。しかし、6ヵ月および12ヵ月の時点における最大歩行距離およびQOL（quality-of-life）スコアの改善は、両群で同様であった。運動群の患者で、1年間のフォローアップ期間中に血行再建術にクロスオーバーした患者はわずか11％であった。 コメント：間欠性跛行患者において、血行再建術の方が運動トレーニングよりも速やかな改善をもたらすことは、驚くにあたらない。しかし、運動群は数ヵ月以内に同じレベルに「追いつく」。血行再建術では合併症が発生しうること、運動は幅広い利益をもたらすことから、この試験は、間欠性跛行の治療の最初のアプローチとして体系的な運動を実施する根拠を補強するものである。 — Allan S. Brett, MD Published in Journal Watch General Medicine February 19, 2009 Citation(s): Spronk S et al. Intermittent claudication: Clinical effectiveness of endovascular revascularization versus supervised hospital-based exercise training — Randomized controlled trial. Radiology 2009 Feb; 250:586. Original article (Subscription may be required) Medline abstract (Free) AU - Spronk, S AU - Bosch, JL AU - den Hoed, PT AU - Veen, HF AU - Pattynama, PM AU - Hunink, MG PY - 2009/02// UR - http://dx.doi.org/10.1148/radiol.2501080607 ER -