Intermittent claudication. Conservative treatment, endovascular repair or open surgery for femoropopliteal disease

Intermittent claudication (IC) has a prevalence of 5-10 % in the population above 70 years old. 50-75 % remains stable without treatment, and the amputation risk is approximately 1 % a year. The most important risk factor is smoking, and cessation can lead to an improvement of 50 % in walking distance. An exercise program for 3 to 6 months is associated with a significant improvement in walking distance in the order of 100 % in the majority of patients. Also pharmacological treatment and weight loss can be of benefit. Endovascular repair in the femoropopliteal segment is associated with a high initial success rate of 90 %, in case of lesions shorter than 5-10 cm. The long-term success is in accordance with the results after conservative treatment, with improvement in 50-60 % of the patients. Infrainguinal bypass surgery has an initial success rate near to 90 %, and a favourable long-term patency of 50-80 %. Vein should be preferred in the below knee bypass. The surgical treatment carries an early mortality of 1% and an amputation rate similar to the untreated patients. In the treatment of IC, conservative treatment with cessation of smoking, physical exercise and risk reduction still is the method of choice. In selected cases with suitable lesions, PTA is a minimal invasive method, with a high short-term success rate, acceptable long-term success and low morbidity. In cases of disabling claudication, with a severe influence on working ability and/or social life, PTA or surgery should be offered to the well-informed patient, who is accepting the risks associated. Further refinement of the available methods, including enhancements in medical treatment, will undoubtedly in the future lead to a more active approach towards treatment of intermittent claudication.