血管内血行再建術と運動の併用は疼痛を軽減する （LBCT 4/Abstract: 19577）

ERASE：運動と血管内血行再建術を併用することにより末梢動脈疾患の間欠性跛行の疼痛が軽減した
ERASE: Combining exercise and endovascular revascularization reduced claudication pain in peripheral artery disease
末梢動脈疾患（PAD）患者において、監視下運動療法を血管内血行再建術と組み合わせることにより、運動療法単独よりも間欠性跛行の疼痛が軽減し歩行距離が増加したとのlate-breaking clinical trialの結果が2013年American Heart Association学会で発表された。Endovascular Revascularization And Supervised Exercise（ERASE）トライアルの研究者らは、下肢の間欠性跛行を有する患者212人を調査した。参加者は、トレッドミル検査による歩行時間計測およびそれによる疼痛などの身体評価、およびスタディ開始時、1、6、12か月後のQOLの評価を受けた。参加者の半分は監視下運動療法を受け、他の半分は血管形成術またはステントにより狭窄を解除された後に監視下運動療法を受けた。治療12か月後に、併用療法を受けた患者は運動療法のみの患者よりも約 282m（0.18マイルまたは約3ブロック）長く歩き、疼痛は少なかった。併用療法群は運動単独群よりも無痛歩行距離を平均1/4マイル増加させることができた。ガイドラインでは間欠性跛行患者の初期治療として監視下運動療法を推奨しているが、今回のスタディ結果から併用療法が最良の選択肢である可能性 のあることが示唆される、と筆者らは述べている。
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Supervised exercise combined with an endovascular revascularization procedure reduced claudication pain and increased walking better than exercise alone in patients with peripheral artery disease (PAD), according to a late-breaking clinical trial presented at the American Heart Association's Scientific Sessions 2013.

Endovascular Revascularization And Supervised Exercise (ERASE) Trialresearchers studied 212 patients with intermittent claudication pain in their legs. They assigned half of the participants to receive supervised exercise and the other half to undergo angioplasty or stenting procedures to open blocked blood vessels followed by supervised exercise.

Twelve months after treatment, patients who received the combined therapies walked about 282 meters (.18 miles or about three blocks) farther, and with less pain, than those in the exercise-only group. The combined-therapy group was able to increase their pain-free walking an average of one quarter of a mile farther than patients in the exercise-only group.

"Although guidelines recommend supervised exercise as initial therapy in patients with intermittent claudication, our data suggest that a combined therapy of the vessel-opening procedure followed by a supervised exercise program might be the best option," said Farzin Fakhry, M.Sc., lead author and a Ph.D. candidate at Erasmus University in Rotterdam, The Netherlands.

Researchers conducted the study in May 2010- March 2013 at 10 centers in the Netherlands. Participants underwent physical assessments including a treadmill test to measure walking duration and associated pain, and quality-of-life assessments at the beginning of the study, and after one, six and 12 months.

Intermittent claudication is a form of peripheral artery disease (PAD).  The most common symptoms of PAD include leg-muscle pain, cramping and fatigue with walking and other activities. Although the leg pain usually stops with rest, it can severely limit movement and quality of life, and often is an early sign of more serious illness, including heart disease and stroke.

Currently, patients seeking treatment for leg pain associated with blocked blood vessels for the first time usually receive only exercise therapy involving treadmill-walking sessions under medical supervision or angioplasty.

 "Based on our study results, this combined therapy of angioplasty or stenting plus exercise therapy should be considered as an initial treatment," Fakhry said.

Risk factors for developing narrow or blocked blood vessels in the legs include smoking, diabetes, and high blood pressure and cholesterol.

Co-authors are Sandra Spronk, Ph.D.; Lijckle van der Laan, M.D., PhD; Jan Wever, M.D., Ph.D.; Joep Teijink, M.D., Ph.D.; Wolter Hoffmann, M.D., Ph.D.; Taco Smits, M.D., Ph.D.; Arie van der Ham, M.D., Ph.D.; Guido Stultiens, M.D.; Alex Derom, M.D.; Ted den Hoed, M.D., Ph.D.; Dimitris Rizopoulos, Ph.D.; Ellen Rouwet, M.D., Ph.D. and Myriam Hunink, M.D., Ph.D.,

ZON-MW and The Netherlands Organization for Health Research and Development funded the study.