• Rafael D Malgor, Fares Alahdab, Fares Alalahdab, Tarig A Elraiyah, Adnan Z Rizvi, Melanie A Lane, Larry J Prokop, Olivia J Phung, Wigdan Farah, Victor M Montori, Michael S Conte, and Mohammad Hassan Murad.
• Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minn; Division of Vascular Surgery, University of Oklahoma, Tulsa, Okla.
• J. Vasc. Surg. 2015 Mar 1; 61 (3 Suppl): 54S-73S.

BackgroundPeripheral arterial disease is common and is associated with significant morbidity and mortality.MethodsWe conducted a systematic review to identify randomized trials and systematic reviews of patients with intermittent claudication to evaluate surgery, endovascular therapy, and exercise therapy. Outcomes of interest were death, amputation, walking distance, quality of life, measures of blood flow, and cost.ResultsWe included eight systematic reviews and 12 trials enrolling 1548 patients. Data on mortality and amputation and on cost-effectiveness were sparse. Compared with medical management, each of the three treatments (surgery, endovascular therapy, and exercise therapy) was associated with improved walking distance, claudication symptoms, and quality of life (high-quality evidence). Evidence supporting superiority of one of the three approaches was limited. However, blood flow parameters improved faster and better with both forms of revascularization compared with exercise or medical management (low- to moderate-quality evidence). Compared with endovascular therapy, open surgery may be associated with longer length of hospital stay and higher complication rate but resulted in more durable patency (moderate-quality evidence).ConclusionsIn patients with claudication, open surgery, endovascular therapy, and exercise therapy were superior to medical management in terms of walking distance and claudication. Choice of therapy should rely on patients' values and preferences, clinical context, and availability of operative expertise.Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

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