Number 41

Improvement of the Walking Abiliy in Intermittent Claudication due to Superficial Femoral Artery Occlusion with Supervised Exercise and Pneumatic Foot and Calf Compresssion

A Randomised Controlled Trial

S.K. Kakkos, G. Geroulakos and A.N. Nicolaides

European Journal of Vascular Surgery, August 2005, Volume 30

Objective: To compare the effec of unsupervised exercise, supervised exercise and intermittent pneumatic foot and calf compression (IPC) on the claudication distance, lower limb arterial haemodynamics and quality of life of patients with intermittent claudication.

Methods: Thirty-four eligible patients with stable intermittent claudication were randomised to IPC (n=13, 3 h/d for 6 months), supervised exercise (n=12, three hourly sessions/week for 6 months) or unsupervised exercise (n=9). In each patient, initial claudication distance (ICD), absolute claudication distance (ACD), resting ankle brachial pressure index (ABPI), and resting hyperaemic calf arterial inflow were measured before 6 weeks, 6 months and 1 year after randomisation. Quality of life was assessed with the short form (SF)-36, walking improvement (WIQ) and intermitent claudication questionnaires (ICQ).

Results: Compared with unsupervised exercise, both IPC and supervised exercise, increased ICD and ACD, up to 2.83 times. IPC increased arterial inflow (p<0.05 at 6 weeks) and ABPI. Supervised exercise decreased arterial inflow and increased ABPI (p<0.05 at 6 moths). Unsupervised exercise had no effect on arterial inflow or ABPI. IPC improved significantly the ICQ score and te speed score of the WIQ, while supervised exxercise improved the WIQ claudication severity score. At 1 year clinical effectiveness of supervised exercise and IPC was largely preserved.

Conclusion: IPC, by augmenting leg perfusion, achieved improvement in walking distance comparable with supervised exercise. Long-term results in a larger number of patients will provide valuable information on the optimal treatment modality of intermittent claudication.

Vascular Unit, Ealing Hospital, Southall, Middlesex, and Department of Vascular Surgery, Imperial College of Science, Technology and Medicine, London, UK.

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