Download PDF
Zentralbl Chir 2022; 147(05): 453-459
DOI: 10.1055/a-1798-0602
Übersicht

Primärtherapie der Claudicatio intermittens – Anspruch und Wirklichkeit

Firstline Therapy of Intermittent Claudication – Claim and Reality
Jan David Süss
1   Gefäßchirurgie, St-Antonius-Hospital gGmbH, Eschweiler, Deutschland (Ringgold ID: RIN39760)
,
Michael Gawenda
1   Gefäßchirurgie, St-Antonius-Hospital gGmbH, Eschweiler, Deutschland (Ringgold ID: RIN39760)
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Zusammenfassung

Die narrative Übersichtsarbeit fasst die Studienlage zum Thema Gehtraining bei Patienten mit Claudicatio intermittens (CI) zusammen. Eindringlich wird auf die evidenzbasierten Leitlinienempfehlungen und die dahinterstehenden Studien eingegangen. Aspekte zum angiomorphologischen Befund, zu Patientenadhärenz, Langzeitwirkung, Studienqualität und ihre Vergleichbarkeit werden diskutiert. Der Problematik in der Versorgungsrealität mit Abweichungen von den Leitlinien und der oftmals invasiven Erstlinientherapie des PAVK-IIb-Patienten werden besondere Bedeutung geschenkt. Dabei wird die Rolle des Rehasports und die gesundheitspolititsche Bedeutung von Gehtraining in Deutschland erörtert. Gründe für die fehlende Leitlinientreue und deren Umsetzung im Gesundheitssystem werden analysiert. Dementsprechend werden Handlungsempfehlungen, in Anlehnung an internationale Erfahrungen (Niederlande, Dänemark), zur Besserung der Situation in Deutschland formuliert.

Abstract

This narrative review summarizes the situation of research concerning exercise therapy in patients suffering from intermittent claudication. In depth we present the evidence-based guidelines and their underlying studies. Aspects as angiomorphology, adherence, long-term effect, quality of studies and their comparability are discussed. We focus on the gap between guidelines and therapy of healthcare providers. Therefore, we discuss the relevance of exercise therapy in healthcare policy. Reasons for the missing congruence between guidelines and the implementation in the healthcare system in Germany are analysed. According to this we express recommendations corresponding to international experiences (Netherlands, Denmark).

Schlüsselwörter

periphere arterielle Verschlusskrankheit - überwachtes Gehtraining - evidenzbasierte Medizin

Keywords

peripheral arterial occlusive disease - supervised exercise therapy - evidence based medicine


Publication History

Received: 07 December 2021

Accepted after revision: 12 March 2022

Article published online:
12 April 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 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: 305-368
    CrossrefPubMedSearch in Google Scholar
  • 2 Gommans LN, Saarloos R, Scheltinga MR. et al. Editor’s choice–The effect of supervision on walking distance in patients with intermittent claudication: a meta-analysis. Eur J Vasc Endovasc Surg 2014; 48: 169-184
    CrossrefPubMedSearch in Google Scholar
  • 3 Makris GC, Lattimer CR, Lavida A. et al. Availability of supervised exercise programs and the role of structured home-based exercise in peripheral arterial disease. Eur J Vasc Endovasc Surg 2012; 44: 569-575
    CrossrefPubMedSearch in Google Scholar
  • 4 Diehm C, Schuster A, Allenberg JR. et al. High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis 2004; 172: 95-105
    CrossrefPubMedSearch in Google Scholar
  • 5 Fowkes FG, Rudan D, Rudan I. et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet 2013; 382: 1329-1340
    CrossrefPubMedSearch in Google Scholar
  • 6 Statistisches Bundesamt. Bevölkerung – Zahl der Einwohner in Deutschland nach relevanten Altersgruppen am 31. Dezember 2019 (in Millionen). Accessed June 30, 2020 at: https://de.statista.com/statistik/daten/studie/1365/umfrage/bevoelkerung-deutschlands-nach-altersgruppen/
    PubMed
  • 7 Rümenapf G, Morbach S, Schmidt A. et al. Intermittent Claudication and Asymptomatic Peripheral Arterial Disease. Dtsch Arztebl Int 2020; 117: 188-193
    CrossrefPubMedSearch in Google Scholar
  • 8 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: 305-368
    CrossrefPubMedSearch in Google Scholar
  • 9 Lawall H, Huppert P, Rümenapf G. S3-Leitlinie zur Diagnostik, Therapie und Nachsorge der peripheren arteriellen Verschlusskrankheit. 2015 https://www.awmf.org/uploads/tx_szleitlinien/065–003l_S3_PAVK_periphere_arterielle_Verschlusskrankheitfinal-2016–04.pdf
    PubMedSearch in Google Scholar
  • 10 Greenhalgh RM, Belch JJ, Brown LC. et al. The adjuvant benefit of angioplasty in patients with mild to moderate intermittent claudication (MIMIC) managed by supervised exercise, smoking cessation advice and best medical therapy: results from two randomised trials for stenotic femoropopliteal and aortoiliac arterial disease. Eur J Vasc Endovasc Surg 2008; 36: 680-688
    CrossrefPubMedSearch in Google Scholar
  • 11 Murphy TP, Cutlip DE, Regensteiner JG. et al. Supervised exercise, stent revascularization, or medical therapy for claudication due to aortoiliac peripheral artery disease: the CLEVER study. J Am Coll Cardiol 2015; 65: 999-1009
    CrossrefPubMedSearch in Google Scholar
  • 12 Bouwens E, Klaphake S, Weststrate KJ. et al. Supervised exercise therapy and revascularization: Single-center experience of intermittent claudication management. Vasc Med 2019; 24: 208-215
    CrossrefPubMedSearch in Google Scholar
  • 13 Lane R, Harwood A, Watson L. et al. Exercise for intermittent claudication. Cochrane Database Syst Rev 2017; (12) CD000990
    CrossrefPubMedSearch in Google Scholar
  • 14 Fokkenrood HJ, Bendermacher BL, Lauret GJ. et al. Supervised exercise therapy versus non-supervised exercise therapy for intermittent claudication. Cochrane Database Syst Rev 2013; (08) CD005263
    CrossrefPubMedSearch in Google Scholar
  • 15 Fakhry F, van de Luijtgaarden KM, Bax L. et al. Supervised walking therapy in patients with intermittent claudication. J Vasc Surg 2012; 56: 1132-1142
    CrossrefPubMedSearch in Google Scholar
  • 16 McDermott MM. Exercise Rehabilitation for Peripheral Artery Disease: A REVIEW. J Cardiopulm Rehabil Prev 2018; 38: 63-69
    CrossrefPubMedSearch in Google Scholar
  • 17 Murphy TP, Cutlip DE, Regensteiner JG. et al. 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. Circulation 2012; 125: 130-139
    CrossrefPubMedSearch in Google Scholar
  • 18 Sutherland ER. Sham procedure versus usual care as the control in clinical trials of devices: which is better?. Proc Am Thorac Soc 2007; 4: 574-576
    CrossrefPubMedSearch in Google Scholar
  • 19 Gardner AW, Parker DE, Montgomery PS. et al. Efficacy of quantified home-based exercise and supervised exercise in patients with intermittent claudication: a randomized controlled trial. Circulation 2011; 123: 491-498
    CrossrefPubMedSearch in Google Scholar
  • 20 Gardner AW, Parker DE, Montgomery PS. et al. Step-monitored home exercise improves ambulation, vascular function, and inflammation in symptomatic patients with peripheral artery disease: a randomized controlled trial. J Am Heart Assoc 2014; 3: e001107
    CrossrefPubMedSearch in Google Scholar
  • 21 Zwierska I, Walker RD, Choksy SA. et al. Upper- vs lower-limb aerobic exercise rehabilitation in patients with symptomatic peripheral arterial disease: a randomized controlled trial. J Vasc Surg 2005; 42: 1122-1130
    CrossrefPubMedSearch in Google Scholar
  • 22 Watson L, Ellis B, Leng GC. Exercise for intermittent claudication. Cochrane Database Syst Rev 2008; (04) CD000990
    CrossrefPubMedSearch in Google Scholar
  • 23 Pandey A, Banerjee S, Ngo C. et al. Comparative Efficacy of Endovascular Revascularization Versus Supervised Exercise Training in Patients With Intermittent Claudication: Meta-Analysis of Randomized Controlled Trials. JACC Cardiovasc Interv 2017; 10: 712-724
    CrossrefPubMedSearch in Google Scholar
  • 24 Saratzis A, Paraskevopoulos I, Patel S. et al. Supervised Exercise Therapy and Revascularization for Intermittent Claudication: Network Meta-Analysis of Randomized Controlled Trials. JACC Cardiovasc Interv 2019; 12: 1125-1136
    CrossrefPubMedSearch in Google Scholar
  • 25 Kruidenier LM, Nicolai SP, Rouwet EV. et al. Additional supervised exercise therapy after a percutaneous vascular intervention for peripheral arterial disease: a randomized clinical trial. J Vasc Interv Radiol 2011; 22: 961-968
    CrossrefPubMedSearch in Google Scholar
  • 26 Bø E, Bergland A, Stranden E. et al. Effects of 12 Weeks of Supervised Exercise After Endovascular Treatment: A Randomized Clinical Trial. Physiother Res Int 2015; 20: 147-157
    CrossrefPubMedSearch in Google Scholar
  • 27 Klaphake S, Buettner S, Ultee KH. et al. Combination of endovascular revascularization and supervised exercise therapy for intermittent claudication: a systematic review and meta-analysis. J Cardiovasc Surg (Torino) 2018; 59: 150-157
    CrossrefPubMedSearch in Google Scholar
  • 28 Mazari FA, Khan JA, Samuel N. et al. Long-term outcomes of a randomized clinical trial of supervised exercise, percutaneous transluminal angioplasty or combined treatment for patients with intermittent claudication due to femoropopliteal disease. Br J Surg 2017; 104: 76-83
    CrossrefPubMedSearch in Google Scholar
  • 29 Nicolaï SP, Hendriks EJ, Prins MH. et al. Optimizing supervised exercise therapy for patients with intermittent claudication. J Vasc Surg 2010; 52: 1226-1233
    CrossrefPubMedSearch in Google Scholar
  • 30 McDermott MM, Kibbe MR, Guralnik JM. et al. Durability of Benefits From Supervised Treadmill Exercise in People With Peripheral Artery Disease. J Am Heart Assoc 2019; 8: e009380
    CrossrefPubMedSearch in Google Scholar
  • 31 Gardner AW, Montgomery PS, Parker DE. Optimal exercise program length for patients with claudication. J Vasc Surg 2012; 55: 1346-1354
    CrossrefPubMedSearch in Google Scholar
  • 32 Guidon M, McGee H. Recruitment to clinical trials of exercise: challenges in the peripheral arterial disease population. Physiotherapy 2013; 99: 305-310
    CrossrefPubMedSearch in Google Scholar
  • 33 McDermott MM, Liu K, Guralnik JM. et al. Home-based walking exercise intervention in peripheral artery disease: a randomized clinical trial. JAMA 2013; 310: 57-65
    CrossrefPubMedSearch in Google Scholar
  • 34 Nicolaï SP, Teijink JA, Prins MH. Multicenter randomized clinical trial of supervised exercise therapy with or without feedback versus walking advice for intermittent claudication. J Vasc Surg 2010; 52: 348-355
    CrossrefPubMedSearch in Google Scholar
  • 35 McDermott MM, Ades P, Guralnik JM. et al. Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication: a randomized controlled trial. JAMA 2009; 301: 165-174
    CrossrefPubMedSearch in Google Scholar
  • 36 Lindgren H, Qvarfordt P, Åkesson M. et al. Primary Stenting of the Superficial Femoral Artery in Intermittent Claudication Improves Health Related Quality of Life, ABI and Walking Distance: 12 Month Results of a Controlled Randomised Multicentre Trial. Eur J Vasc Endovasc Surg 2017; 53: 686-694
    CrossrefPubMedSearch in Google Scholar
  • 37 Fakhry F, Spronk S, van der Laan L. et al. Endovascular Revascularization and Supervised Exercise for Peripheral Artery Disease and Intermittent Claudication: A Randomized Clinical Trial. JAMA 2015; 314: 1936-1944
    CrossrefPubMedSearch in Google Scholar
  • 38 van den Houten MM, Gommans LN, van der Wees PJ. et al. Minimally Important Difference of the Absolute and Functional Claudication Distance in Patients with Intermittent Claudication. Eur J Vasc Endovasc Surg 2016; 51: 404-409
    CrossrefPubMedSearch in Google Scholar
  • 39 Gardner AW, Montgomery PS, Wang M. Minimal clinically important differences in treadmill, 6-minute walk, and patient-based outcomes following supervised and home-based exercise in peripheral artery disease. Vasc Med 2018; 23: 349-357
    CrossrefPubMedSearch in Google Scholar
  • 40 Schwaab B, Rauch B, Bjarnason-Wehrens B. et al. S3-Leitlinie Kardiologische Rehabilitation im deutschsprachigen Raum Europas (D-A-CH). AWMF-Registernummer: 133–001. https://www.awmf.org/uploads/tx_szleitlinien/133–001l_S3-Kardiologische-Rehabilitation-in-D-A-CH_2020–12.pdf
    PubMed
  • 41 Knöppel P. Gibt es eigentlich die Wegeunfähigkeit noch. https://rentenbescheid24.de/gibt-es-ueberhaupt-noch-die-wegeunfaehigkeit/
    PubMed
  • 42 van Asselt AD, Nicolaï SP, Joore MA. et al. Cost-effectiveness of exercise therapy in patients with intermittent claudication: supervised exercise therapy versus a ‘go home and walk’ advice. Eur J Vasc Endovasc Surg 2011; 41: 97-103
    CrossrefPubMedSearch in Google Scholar
  • 43 Fakhry F, Fokkenrood HJ, Spronk S. et al. Endovascular revascularisation versus conservative management for intermittent claudication. Cochrane Database Syst Rev 2018; (03) CD010512
    CrossrefPubMedSearch in Google Scholar
  • 44 Lauret GJ, Gijsbers HJ, Hendriks EJ. et al. The ClaudicatioNet concept: design of a national integrated care network providing active and healthy aging for patients with intermittent claudication. Vasc Health Risk Manag 2012; 8: 495-503
    CrossrefPubMedSearch in Google Scholar
  • 45 Lauret GJ, van Dalen HC, Hendriks HJ. et al. When is supervised exercise therapy considered useful in peripheral arterial occlusive disease? A nationwide survey among vascular surgeons. Eur J Vasc Endovasc Surg 2012; 43: 308-312
    CrossrefPubMedSearch in Google Scholar
  • 46 Hageman D, Lauret GJ, Gommans LNM. et al. Supervised Exercise Therapy for Intermittent Claudication Is Increasingly Endorsed by Dutch Vascular Surgeons. Ann Vasc Surg 2018; 47: 149-156
    CrossrefPubMedSearch in Google Scholar
  • 47 Aaij AGL, Wermelink B, Haalboom M. et al. Real World Practice Deviation from Nationwide Guidelines in Patients with Intermittent Claudication. Eur J Vasc Endovasc Surg 2021; 62: 432-438
    CrossrefPubMedSearch in Google Scholar
  • 48 Jensen JD, Tang LH, Zwisler AO. et al. National survey of current practice and opinions on rehabilitation for intermittent claudication in the Danish Public Healthcare System. Scand Cardiovasc J 2019; 53: 361-372
    CrossrefPubMedSearch in Google Scholar