Role of revascularization in the treatment of claudication.

Intermittent claudication is a relative indication for vascular reconstruction. Conservative management with a combination of risk factor control, exercise training and medical therapy will relieve or at least improve claudication in some patients. If claudication precludes gainful employment or imposes an unacceptable alteration in lifestyle, surgical revascularization should be considered. Surgical bypass for claudication will produce optimal results in younger patients, in whom near-normalization of the ankle/brachial index can be anticipated. Proximal axial (in-line) reconstructions maintain their patencies longer than more distal, and often technically more challenging, bypasses. These tenets also apply well to percutaneous transluminal angioplasty. Both surgical and catheter-based interventions carry potential risks of short- and long-term morbidity, although overall morbidity associated with surgery for claudication is acceptably low. Interventions are justified only if they are safe, effective and durable, and if they are performed after the long-term prognosis for both life and limb is considered.