Intermittent claudication is evident as pain in the leg that becomes apparent when walking and is relieved by rest. The pain is the result of insufficient blood flow to the calf muscles when exercising, generally because of atherosclerotic changes in the leg arteries so that a section becomes narrowed or blocked. People with mild disease are advised to stop smoking, exercise, and take low-dose aspirin to prevent heart attack or stroke. There is no widely accepted medication to treat claudication. Angioplasty involves using a balloon, laser or mechanical device threaded down a leg artery to widen and open the narrowed or blocked section. Possible side effects of the procedure include blood clots and movement of blood clots and debri (emboli). The immediate effect may be to relieve the symptoms but narrowing can reoccur.
The review authors identified two controlled trials from the UK . A total of 98 participants took part. Their average age was 62 years and only 20 were women. The participants were randomised to have either angioplasty or, in one trial, to follow an exercise program or, in the other, to receive advice on smoking, aspirin and exercise. Six months later, both trials showed improvements in leg blood flow in the people who had angioplasty, measured by comparing pressures at the ankle and the arm (mean ankle brachial pressure index). In one trial, the distance walked on a treadmill improved more with exercise than angioplasty at six months and at one year. No benefits of angioplasty were evident six years after surgery. In the other trial, blood flow was still improved two years after angioplasty but walking distance without pain, which had improved at six months, and quality of life were no better than for participants receiving advice only. Only these two trials with relatively small numbers of participants contributed to the conclusion that angioplasty provides only short-term benefits.