Endovascular Revascularization Benefits PAD Patients When Added to Exercise Therapy

DALLAS, TX—The combination of endovascular revascularization plus supervised exercise therapy in patients with peripheral artery disease (PAD) and intermittent claudication results in greater improvements in maximum walking distance and quality of life compared with exercise therapy alone. Late breaking results of the multicenter ERASE (Endovascular Revascularization and Supervised Exercise) trial were presented November 18, 2013, at the annual American Heart Association Scientific Sessions.

Farzin E. Fakhry, MD, of Erasmus Medical Center (Rotterdam, The Netherlands), and colleagues randomized 212 PAD patients with stable intermittent claudication and vascular obstruction > 50% to receive supervised exercise therapy with (n = 106) or without (n = 106) endovascular revascularization. Walking distances were measured using the treadmill test and quality of life was assessed with the VascuQuol and Short-Form 36 Health Survey (SF-36).

A Successful Combination

After 12 months, follow-up was obtained in the vast majority of patients in both the combination- (94%) and single-therapy (92%) groups. Compared with supervised exercise alone, combination therapy was associated with greater improvements in maximum and pain-free walking distances. In addition, the disease-specific VascuQuol survey showed greater mean improvement in quality of life with the addition of endovascular revascularization (table 1).

Table 1. Improvements From Combination Therapy vs. Exercise Therapy Alone at 1 Year

Economic, Geographic Barriers to Exercise Remain

Discussant Mary McGrae McDermott, MD, of Northwestern University (Chicago, IL), commented that the benefits of exercise therapy plus revascularization were “greatest in the short term.” Longer follow-up may show no difference in outcomes, she added, as benefits seemed to diminish over time.

Additionally, treadmill walking is not representative of walking in daily life and can be “associated with a learning effect,” Dr. McDermott said. “Clinically meaningful change in treadmill walking performance is not defined, but the six-minute walk test overcomes these limitations.”

With regard to the amount of supervised exercise necessary, she explained that although current AHA/ACC guidelines recommend three times per week, ERASE prescribed 2-3 sessions per week in the first 3 months and then reduced these to weekly sessions in months 4-6 and to monthly sessions in months 7-12. If the trial had rigidly adhered to guidelines, the results may have turned out differently, Dr. McDermott surmised.

Accessibility is also an issue, she observed, as Medicare does not cover supervised exercise and “frequent travel . . . is burdensome” for frail patients. “Future studies should identify exercise programs for PAD that overcome these barriers.”

 

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Source:
Fakhry FE. Randomized comparison of endovascular revascularization plus supervised exercise therapy versus supervised exercise therapy only in patients with peripheral artery disease and intermittent claudication: Results of the endovascular revascularization and supervised exercise (ERASE) trial. Presented at: American Heart Association Scientific Sessions; November 18, 2013; Dallas, TX.

 

 

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