The Society for Vascular Surgery (SVS) recently published comprehensive update to its clinical practice guidelines (CPGs) for the management of intermittent claudication (IC), urging clinicians to prioritize conservative treatment strategies and patient-centered care.
The new recommendations, which appeared in the August issue of the Journal of Vascular Surgery (JVS), incorporate nearly a decade of new evidence and mark the first time the SVS has included a formal patient panel in the guideline development process.
The IC guidelines writing group, led by first author Michael Conte, MD, chief of the Division of Vascular and Endovascular Surgery at the University of California San Francisco (UCSF), produced 12 formal recommendations and two best practice statements, focusing on antithrombotic therapy, exercise interventions and revascularization procedures.
The update is intended to provide clinicians with the best available contemporary data on optimal medical therapy (OMT), exercise and interventions to promote an evidence-based framework for the management of IC. The guidelines reaffirm that first-line treatment should include patient education, smoking cessation, risk factor control, optimal medical therapy and structured exercise programs. Revascularization—whether surgical or endovascular—is recommended only for patients with lifestyle-limiting symptoms who do not respond to conservative therapy.
The guideline development process included input from a panel of patient advisors with lived experience of peripheral arterial disease (PAD) and claudication. Their feedback emphasized the importance of clear communication, individualized treatment goals and transparency about risks and benefits.
Despite advances in pharmacotherapy and endovascular technology, the SVS identified several gaps in the evidence base, including limited data on long-term outcomes and the effectiveness of home-based exercise programs.
“The areas selected for focus concern the role of therapeutic interventions for patients with IC,” Conte et al write. “Within the domain of medical therapies, we focused on antithrombotic management because of important new evidence in this arena directly relevant to the patient with IC.”
The updated guidelines aim to shift clinical practice toward a more thoughtful, individualized model of care, encouraging clinicians to weigh treatment options in the context of each patient’s overall health, preferences and life goals.
“In addition to the 2015 SVS guideline document on IC, the reader should refer to other relevant multi-specialty guidelines on general cardiovascular risk management and preoperative evaluation for patients with PAD and IC to supplement this update,” Conte and colleagues add in the update.
In an editorial accompanying the guidelines in the August issue of JVS, Britt Tonnessen, MD, an associate professor of vascular surgery at Yale Medicine in New Haven, Connecicut, and Marc Schermerhorn, MD, chief of vascular surgery at Beth Israel Deaconess Medical Center in Boston, say that such SVS guidelines provide “in-depth, evidence-based updates without recapping every aspect of a vascular condition.”
“The SVS has a responsibility to remain steadfast in the sharing of evidence that helps our patients and members,” they write. “This latest CPG on intermittent claudication is rooted in quality and safety, and encourages a patient-centered approach to the management of intermittent claudication—we would encourage everyone to read and consider which parts may best benefit their patients.”
Visit vascular.org/ICFocusedUpdate.
