# Retrospective Cohort Study Analysing Response to Supervised Exercise Therapy and Subsequent Revascularization in Patients with Intermittent Claudication

## TL;DR

This study found that patients with intermittent claudication who improved significantly in walking distance after supervised exercise therapy were less likely to need further revascularization surgery.

## Contribution

The study identifies a specific threshold of improvement in walking distance that predicts the need for revascularization after supervised exercise therapy.

## Key findings

- Patients with ≥75% improvement in Pain Onset Distance were less likely to need revascularization (p < 0.019).
- Smokers were significantly less likely to require further revascularization (p < 0.05).
- Previous revascularization increased the likelihood of needing further surgery (p = 0.0071).

## Abstract

Background: All major international and national guidelines recommend supervised exercise therapy (SET) for intermittent claudication (IC) as a first line of treatment, with revascularisation options to be considered for those who do not respond. Revascularisation incurs complication risks and additional costs; therefore, the need to correctly identify individuals who potentially may progress to revascularisation following SET would be of benefit. This retrospective cohort study aimed to review responses and subsequent revascularisation for individuals with IC following completion of SET. Methods: Retrospective data was collated for individuals who received hospital-based SET between 2016 and 2020. Demographics, Pain Onset Distance (POD), revascularisation (pre- and post-completion of SET) and quality of life (QoL) were calculated. Results: A total of 142 individuals were included; of those, 38 had diabetes, 48 were current smokers and 42 were female. Individuals who had a ≥75% improvement in POD were less likely to need revascularisation (p < 0.019). Gender, diabetes, and age did not imply likelihood of preventing revascularisation. Those who smoked were significantly less likely to go on to further revascularisation (p < 0.05) and those who had previous revascularisation surgery (n = 25) were significantly more likely to require further revascularisation (p = 0.0071) (32% compared with 10%). A mean positive improvement (1.77%) was seen in the EQ5D5L overall health percentage score for individuals who avoided surgery. Conclusions: Individuals who saw a ≥75% in POD were statistically less likely to require revascularisation post-SET. Improvements in QoL increase the probability of avoiding revascularisation.