Supervised exercise versus primary stenting for claudication resulting from aortoiliac peripheral artery disease: six-month outcomes from the claudication: exercise versus endoluminal revascularization (CLEVER) study.

Abstract

BACKGROUND:

Claudication is a common and disabling symptom of peripheral artery disease that can be treated with medication, supervised exercise (SE), or stent revascularization (ST).

METHODS AND RESULTS:

We randomly assigned 111 patients with aortoiliac peripheral artery disease to receive 1 of 3 treatments: optimal medical care (OMC), OMC plus SE, or OMC plus ST. The primary end point was the change in peak walking time on a graded treadmill test at 6 months compared with baseline. Secondary end points included free-living step activity, quality of life with the Walking Impairment Questionnaire, Peripheral Artery Questionnaire, Medical Outcomes Study 12-Item Short Form, and cardiovascular risk factors. At the 6-month follow-up, change in peak walking time (the primary end point) was greatest for SE, intermediate for ST, and least with OMC (mean change versus baseline, 5.8±4.6, 3.7±4.9, and 1.2±2.6 minutes, respectively; P<0.001 for the comparison of SE versus OMC, P=0.02 for ST versus OMC, and P=0.04 for SE versus ST). Although disease-specific quality of life as assessed by the Walking Impairment Questionnaire and Peripheral Artery Questionnaire also improved with both SE and ST compared with OMC, for most scales, the extent of improvement was greater with ST than SE. Free-living step activity increased more with ST than with either SE or OMC alone (114±274 versus 73±139 versus -6±109 steps per hour), but these differences were not statistically significant.

CONCLUSIONS:

SE results in superior treadmill walking performance than ST, even for those with aortoiliac peripheral artery disease. The contrast between better walking performance for SE and better patient-reported quality of life for ST warrants further study.

CLINICAL TRIAL REGISTRATION:

URL: http://clinicaltrials.gov/ct/show/NCT00132743?order=1. Unique identifier: NCT00132743.

• Authors: Timothy P Murphy, Donald E Cutlip, Judith G Regensteiner, Emile R Mohler, David J Cohen, Matthew R Reynolds, Joseph M Massaro, Beth A Lewis, Joselyn Cerezo, Niki C Oldenburg, Claudia C Thum, Suzanne Goldberg, Michael R Jaff, Michael W Steffes, Anthony J Comerota, Jonathan Ehrman, Diane Treat-Jacobson, M Eileen Walsh, Tracie Collins, Dalynn T Badenhop, Ulf Bronas, Alan T Hirsch, CLEVER Study Investigators
• Journal: Circulation (Circulation) Vol. 125 Issue 1 Pg. 130-9 (Jan 03 2012) ISSN: 1524-4539 [Electronic] United States
• PMID: 22090168 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Aorta (pathology)
• Exercise Test (instrumentation, methods)
• Female
• Femoral Artery (pathology)
• Follow-Up Studies
• Humans
• Iliac Artery (pathology)
• Intermittent Claudication (physiopathology, psychology, therapy)
• Male
• Middle Aged
• Myocardial Revascularization (instrumentation, methods)
• Peripheral Arterial Disease (physiopathology, psychology, therapy)
• Popliteal Artery (pathology)
• Prospective Studies
• Quality of Life (psychology)
• Stents
• Treatment Outcome
• Walking (physiology)