Don’t use interventions (including surgical bypass, angiogram, angioplasty or stent) as a first line of treatment for most patients with intermittent claudication.
A trial of smoking cessation, risk factor modification, diet and exercise, as well as pharmacologic treatment should be attempted before most procedures. When indicated, the type of intervention (surgery or angioplasty) depends on several factors.
Intermittent claudication can vary due to several factors. The life-time 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 where the claudication limits a person’s ability to carry out normal daily functions, it is appropriate to intervene.
Depending upon the characteristics of the occlusive process, and patient comorbidities, the best option for treatment may be either surgical or endovascular.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
The Society for Vascular Surgery (SVS) formed a task force to gather initial recommendations for a list of procedures that should not be performed, performed rarely or performed only under certain circumstances. These draft recommendations were then sent to the Public and Professional Outreach Committee, which refined them before presenting them to its reporting council, the Clinical Practice Council. The Council reviewed the citations and ensured all recommendations aligned with SVS Clinical Practice Guidelines before submitting them to the Executive Committee of the SVS Board of Directors for approval. You can review the society’s conflict of interest and disclosure policy at www.vsweb.org/COIindustrypolicy.
Lane R, Harwood A, Watson L, Leng GC. Exercise for intermittent claudication. Cochrane Database Syst Rev. 2017;12(12):CD000990. Published 2017 Dec 26. doi:10.1002/14651858.CD000990.pub4
Bath J, Lawrence PF, Neal D, et al. Endovascular interventions for claudication do not meet minimum standards for the Society for Vascular Surgery efficacy guidelines [published correction appears in J Vasc Surg. 2021 Oct;74(4):1436]. J Vasc Surg. 2021;73(5):1693-1700.e3. doi:10.1016/j.jvs.2020.10.067
Fakhry F, Fokkenrood HJ, Spronk S, Teijink JA, Rouwet EV, Hunink MGM. Endovascular revascularisation versus conservative management for intermittent claudication. Cochrane Database Syst Rev. 2018;3(3):CD010512. Published 2018 Mar 8. doi:10.1002/14651858.CD010512.pub2
Hicks CW, Holscher CM, Wang P, Black JH 3rd, Abularrage CJ, Makary MA. Overuse of early peripheral vascular interventions for claudication. J Vasc Surg. 2020;71(1):121-130.e1. doi:10.1016/j. jvs.2019.05.005
Aboyans V, Ricco JB, Bartelink MEL, et al. Editor’s Choice – 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(3):305-368. doi:10.1016/j.ejvs.2017.07.018