One question that remains from the current study is whether revascularization plus exercise changes the rates of adverse events seen among patients with intermittent claudication.
While results of the network meta-analysis showed benefit for combination percutaneous transluminal angioplasty and supervised treadmill exercise therapy in terms of efficacy, no data on adverse events were reported. Other studies have revealed that exercise therapy does not increase rates of adverse events in patients with peripheral arterial disease, but this may not be the case with PTA.
A recent study showed the rates of serious adverse events, such as adverse limb events, myocardial infarction, stroke, or death, in a group of patients with intermittent claudication who underwent PTA. While the event rates were low, the follow-up period was short (30 days). Further studies have also shown that responses to PTA alone may not be long lasting.
In a similar manner, the long-term efficacy and safety of PTA plus SET remains unknown. In addition, questions surrounding the statistical significance of quality of life measures from the network meta-analysis also remain.
Rather than encouraging more PTA procedures, results of this network meta-analysis should encourage increased participation in SET by patients with PAD.
Mary M. McDermott, MD, professor of medicine at Northwestern University in Chicago, made these comments in an editorial. She reported financial affiliations with the National Heart Lung and Blood Institute, the National Institute on Aging, and Regeneron (JACC Cardiovasc Interv. 2019 May 29).
