Abstract
BACKGROUND: Intermittent claudication (IC) is a hallmark symptom of peripheral arterial disease (PAD), causing pain and discomfort during physical activity caused by reduced blood flow to the lower extremities. The condition significantly impairs mobility and quality of life (QoL) in affected individuals. Treatment options for IC range from conservative approaches, including best medical therapy (BMT) and supervised exercise therapy (SET), to invasive interventions like angioplasty and open re-vascularization. AIM: This meta-analysis and systematic review seek to assess the long-term results of invasive procedures concerning Noninvasive treatments for the management of patients with IC. METHODS: A comprehensive search was conducted in October 2024 across databases containing PubMed, MEDLINE, Cochrane Library, Embase, and Scopus. Randomized controlled trials (RCTs) comparing invasive interventions to Noninvasive treatments were included. Primary outcomes were quality of life (QoL), ankle-brachial pressure index (ABPI), and maximum walking distance (MWD). Secondary outcomes were major adverse cardiovascular events (MACE), mortality, complications, and re-intervention rates. Data analysis was conducted using the Cochrane Review Manager 5. Follow-up duration was between 2 and 7 years, longest available between 2 and 7 years; prioritized 2 years when present. RESULTS: A total of 11 RCTs with 1379 patients were included in the analysis. Invasive treatments demonstrated a significant improvement in MWD and ABPI compared to Noninvasive treatments (MWD pooled Mean Difference (MD) = 64.94 [10.77, 115.12] 95% CI, p = .02, 5 studies, and ABPI pooled MD = 0.15 [0.04, 0.26] 95% CI, p = .006, 5 studies). However, invasive interventions were associated with a higher rate of complications, including increased amputation risk (Pooled odds ratio (OR) = 2.46 [0.44, 13.94] 95% CI, p = .31, 3 studies), though this was not statistically significant. Long-term rates were higher in the Noninvasive treatment group (Pooled OR: 0.56 [0.33, 0.97] 95% CI, p = .04). CONCLUSIONS: Both invasive and Noninvasive treatments are effective in managing IC. Invasive treatments provide greater improvement in blood flow and walking distance, but the risk of complications and re-interventions should be considered in treatment decisions. Further research with larger sample sizes and designed for long-term assessment is needed to assess the cost-effectiveness and long-term outcomes of invasive treatments.