Disclosure
Speaker name: Prof. Ulrich Hoffmann
University Hospital Munich
I have the following potential conflicts of interest to
report:
Consulting
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
Other(s)
X I do not have any potential conflict of interest
University Hospital LMU München
SFA lesions should primarily be treated conservatively
Ulrich Hoffmann
Dept. of Angiology
University Hospital Munich, Germany
University Hospital LMU München
Outcome of intermittent claudication
100 pts. presenting to doctor with IC
5 y limb outcome 5 y systemic
outcome
75 stabilise 25 5 to 10 30 will die 55 to 60 will be alive
or improve will deteriorate non-fatal CV without CV events
events
5 interventions 16 cardiac
2 major amputations 4 cerebral
3 other vascular
7 non-vascular
TASC, Int Angiol 2000, 19, Suppl. 1
University Hospital LMU München
Treatment for IC....
• Should not expose the patient to
additional risks for deteorating
claudication or for limb loss
• Should not expose the patient to
additional risk for CV events and
mortality
• Should be effective and durable
University Hospital LMU München
Pooled results of femoropopliteal catheter
interventions
1-y patency 3-y patency 5-y patency
(%) (%) (%)
PTA 77 (78 – 80) 61 (55-68) 55 (52-62)
(stenosis)
PTA 65 (55 – 71) 48 (40 – 55) 42 (33 – 51)
(occlusion)
PTA/Stent 75 (73 – 79) 66 (64 – 70) -
(stenosis)
PTA/Stent 73 (69 – 75) 64 (59 – 67) -
(occlusion)
Predictors of restenosis: length of lesion, femoral vs popliteal, outflow disease
Complication rate: 1-12 %
Muradin et al. Radiology 2001;221:137
TASC II Eur J Vasc Endovasc Surg 2007;33 Supl.1
TASC I, Int Angiol 2000, 19, Suppl. 1
University Hospital LMU München
Outcome following femoropopliteal bypass
5 y patency (%)
Vein 74 – 76 %
PTFE 39 – 52 %
TASC II Eur J Vasc Endovasc Surg 2007;33 Supl.1
Early complication rate: 5 - 10 % (TASC I, Int Angiol 2000, 19, Suppl. 1)
30-day mortality rate: 0,7 – 4,4 % (NHS Economic Evaluation Database, 2002
deVries Radiology 2000;222:25)
Failed femoropoliteal grafts for IC carry a substantial risk of
limb loss, especially when vein is not used (19/55 failed PTFE
grafts) (Renwick Br J Surg 1999;86:639)
University Hospital LMU München
Exercise training in intermittent claudication
• improves pain free walking
time by an avarage of 180
%, improves QoL
• has no associated
mortality and morbidity
• improves blood pressure,
blood lipids and glycemic
control
• potentially reduces CV risk
Gardner AW, Poehlman ET. JAMA 1995;274:975-80.
Hall JA, Barnard J. J Cardiac Rehabil 1982;2:569-74.
Rosfors S, Bygdeman S, Arnetz BB, et al. Scand J Rehabil Med 1989;21:7-11.
University Hospital LMU München
Cilostazol for IC
• Improvement in Walking Distance measured in 9 Efficacy Trials with
reproducible Statistical Significance and Clincally meaningful Effect
nd
(for 6 of the 9 Trials) pto ms a
e sym
improv AD a
nd
to yP
• In 1 Efficacy Trial: e rapy extremit
5): ective th lower
99% in Pain-free 00 eff Claudication Distance ( p=0,0001)
(2 (Initial) ith
i de line s an nts w
a tie
86% GuMaximum (Absolute) Claudication Distance (p=0,0001)
C in dicated
/ AC ce in pa
AHA azol is in g distan .
• Cilost e walkinIn iQuality of Life (SF-36) measured in 5 of the Efficacy
Improvement tion
as u d ca
Trials ttent cla
incre i
rm lA
Leve
inteBodily Pain:
, 4x better (p=0,0001)
Cl a ss 1
Physical Function: 4x better (p=0,0001)
Role Physical: 6x better (p=0,0004)
University Hospital LMU München
The patient with IC should be informed
about...
• the minimal risk for amputation
• the limited durability and associated
risks of revascularization
• effective conservative measures
• their high risk for CV events
University Hospital LMU München
Treatment strategy for IC
TASC II Eur J Vasc Endovasc Surg 2007;33 Supl.1
University Hospital LMU München
Thank you for your attention !