CONSERVATIVE MANAGEMENT OF INTERMITTENT CLAUDICATION

Objective: To review the evidence for efficacy of three contemporary treatments for intermittent claudication: pentoxifylline, exercise programs, and smoking cessation. Data Identification: English-language literature search using MEDLINE, Index Medicus, and bibliographic reviews of major texts and all pertinent articles. Study Selection: For pentoxifylline, randomized, double-blind controlled trials were selected. For exercise, all controlled trials were selected, because few randomized trials have been done. For smoking cessation, 26 pertinent studies were selected after an exhaustive search. Data Extraction: Study quality was evaluated; therapeutic efficacy was estimated for pentoxifylline and exercise using metaanalytic techniques. For smoking cessation, all outcomes were determined and described. Results: For pentoxifylline, insufficiently reported data led to marked disparity in effect sizes, preventing a meaningful pooled estimate of effectiveness. The results for exercise therapy suggested that dynamic exercise is beneficial (pooled effect size for pain-free walking distance = 1.03; 95% CI, 0.6 to 1.5; P < 0.0001). Finally, smoking cessation was associated with a reduced frequency of complications due to progressive disease and improved postoperative graft patency rates. Conclusions: The limited amount and quality of reported data precluded an overall, reliable estimate of pentoxifylline's efficacy. Structured exercise programs increased pain-free walking distance, and smoking cessation improved postoperative graft patency rates and reduced the complications of peripheral arterial disease.