May 2023
Again... avoid early peripheral vascular intervention for stable claudication

In a four-year observational study, patients with claudication who underwent invasive intervention within six months of diagnosis had higher rates of adverse outcomes.

Recent evidence suggests that early invasive peripheral vascular intervention (e.g. angioplasty, stenting, atherectomy) should be avoided in patients with intermittent vascular claudication and no evidence of limb-threatening ischaemia (J Vasc Surg 2021; 74: 771-779). In this new study, researchers used US Medicare claims data to identify 187,000 patients with new diagnoses of claudication between 2015 and 2017. Within six months after first diagnosis of claudication, about 6000 patients underwent peripheral vascular intervention, despite no documentation of limb-threatening ischaemia. Long-term outcomes for these patients were compared with outcomes in the 181,000 patients who did not undergo early intervention.

During median follow up of 4.4 years, patients who underwent early invasive intervention – compared with those who did not – were more likely to undergo additional peripheral vascular interventions (23% vs 4%); adjustment for demographic variables, comorbidities and selected physician factors did not alter this sixfold difference. Patients who received early intervention also were more likely to develop chronic limb-threatening ischaemia (16% vs 8%) and to undergo a major amputation (1.0% vs 0.4%). 

Comment: Stable patients with intermittent vascular claudication should receive noninvasive medical management. Invasive management should be reserved for patients with limb-threatening ischaemia or for patients whose claudication becomes severe enough that they are willing to accept the potential complications of invasive intervention. One limitation of this study is that information about severity of claudication and reasons for early intervention are lacking, given that Medicare claims were the source of the data.

Allan S. Brett, MD, Clinical Professor of Medicine, University of Colorado School of Medicine, Aurora, USA.

Sorber R, et al. Early peripheral vascular interventions for claudication are associated with higher rates of late interventions and progression to chronic limb threatening ischemia. J Vasc Surg 2023; 77: 836-847.

This summary is taken from the following Journal Watch titles: General Medicine, Cardiology, Ambulatory Medicine, Hospital Medicine.

J Vasc Surg