Summary of the Best Evidence for Patient Self-management after Lower Extremity Interventions for Arteriosclerosis Obliterans
Objective: To retrieve and summarize the evidence on self-management among patients following lower-extremity atherosclerosis interventions and provide a reference for self-management practices in this population. Methods: Based on the ‘6S’ pyramid of evidence model, a systematic search was performed on BMJ Best Practice, UpToDate, Cochrane Library, Joanna Briggs Institute (JBI), National Institute for Health and Clinical Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), National Guidelines Collection (NGC), Medlive, American Society for Vascular Surgery, American College of Cardiology (ACC), American Heart Association (AHA), European Society of Cardiology (ESC), PubMed, CINAHL, MEDLINE, Web of Science, China Biomedical Literature Database, CNKI, Wanfang database and VIP database for evidence related to self-management in patients with lower extremity arteriosclerosis obliterans after intervention, with a timeframe for searching from database construction to January 2025. After quality assessment and combined with professional judgment, evidence was extracted and summarized from the included literature. Result: 28 articles were included, including 2 clinical decisions, 3 guidelines, 3 evidence summaries, 17 systematic reviews, and 3 randomized controlled trials. Thirty-seven items of best evidence were summarized around seven topics: exercise management, smoking cessation management, medication management, management of associated comorbidities, diet and nutrition management, psychological management, and others. Conclusion: This study provides evidence-based self-management recommendations for healthcare professionals and patients to carry out viable and scientific self-management after LEASO intervention.
[1] Vascular Surgery Group of the Chinese Medical Association Surgical Branch, 2016, Guidelines for the Diagnosis and Treatment of Lower Limb Atherosclerotic Occlusive Disease. Chin Arch Gen Surg (Electron Ed), 10(1): 1–18.
[2] Criqui M, Matsushita K, Aboyans V, et al., 2021, Lower Extremity Peripheral Artery Disease: Contemporary Epidemiology, Management Gaps, and Future Directions: A Scientific Statement from the American Heart Association. Circulation, 144(9): e171–e191.
[3] Wang Z, Wang X, Hao G, et al., 2019, A National Study of the Prevalence and Risk Factors Associated with Peripheral Arterial Disease from China: The China Hypertension Survey, 2012–2015. Int J Cardiol, 275: 165–170.
[4] Gao X, Tong Z, Wu Y, et al., 2021, Similarities and Differences in Peripheral Artery Disease Between China and Western Countries. J Vasc Surg, 74(4): 1417–1424.
[5] Watson W, Mosarla R, Secemsky E, 2023, Endovascular Interventions for Peripheral Artery Disease: A Contemporary Review. Curr Cardiol Rep, 25(11): 1611–1622.
[6] Liu W, Feng L, Meng F, et al., 2017, Analysis of the Effect of Interventional Therapy for Lower Limb Atherosclerotic Occlusive Disease and Factors Affecting Postoperative Recurrence. J Interv Radiol, 26(6): 514–517.
[7] Horváth L, Boncz I, KíVés Z, et al., 2023, Disease-Specific Quality of Life Among Patients with Peripheral Artery Disease in Hungary. Int J Environ Res Public Health, 20(4): 3558.
[8] Brouwers M, Kho M, Browman G, et al., 2010, AGREE II: Advancing Guideline Development, Reporting and Evaluation in Health Care. J Clin Epidemiol, 63(12): 1308–1311.
[9] Hu Y, Hao Y, Li X, et al., 2019, Evidence-Based Nursing. 2nd ed. Beijing: People’s Medical Publishing House.
[10] Foster M, Shurtz S, 2013, Making the Critical Appraisal for Summaries of Evidence (CASE) for Evidence-Based Medicine (EBM): Critical Appraisal of Summaries of Evidence. J Med Libr Assoc, 101(3): 192–198.
[11] Dosluoglu H, 2025, Endovascular Techniques for Lower Extremity Revascularization. UpToDate.
[12] Davies M, 2025, Management of Symptomatic Peripheral Artery Disease: Claudication. UpToDate.
[13] Pearson V, 2024, Intermittent Claudication: Exercise.
[14] Ortega-Arroyo A, 2023, Peripheral Arterial Disease: Risk Factor Modification.
[15] Lu S, Zhang Y, Huang Y, et al., 2024, Summary of Evidence on Exercise Therapy for Patients with Lower Limb Atherosclerotic Occlusive Disease with Intermittent Claudication. Evid Based Nurs, 10(14): 2484–2491.
[16] Gornik H, Aronow H, Goodney P, et al., 2024, 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 149(24): e1313–e1410.
[17] Mazzolai L, Teixido-Tura G, Lanzi S, et al., 2024, 2024 ESC Guidelines for the Management of Peripheral Arterial and Aortic Diseases. Eur Heart J, 45(36): 3538–3700.
[18] Nordanstig J, Behrendt C, Baumgartner I, et al., 2024, Editor’s Choice – European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication. Eur J Vasc Endovasc Surg, 67(1): 9–96.
[19] Xiao Y, Li W, Zhang L, et al., 2024, Effect of Supervised Exercise Training on Cardiovascular Function in Patients with Intermittent Claudication: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clin Res Cardiol, 115(8): 1255–1271.
[20] Abaraogu U, Dall P, Seenan C, et al., 2024, Effect of Behavior-Change Interventions on Daily Physical Activity in Patients with Intermittent Claudication: The OPTIMA Systematic Review and Meta-Analysis. Eur J Prev Cardiol, 32(2): 156–168.
[21] Liang X, Wang Y, Zhao C, et al., 2022, Systematic Review of the Efficacy and Safety of Cilostazol, Pentoxifylline, Beraprost in the Treatment of Intermittent Claudication: A Network Meta-Analysis. PloS One, 17(11): e0275392.
[22] Thanigaimani S, Phie J, Sharma C, et al., 2021, Network Meta-Analysis Comparing the Outcomes of Treatments for Intermittent Claudication Tested in Randomized Controlled Trials. J Am Heart Assoc, 10(9): e019672.
[23] Kim M, Kim C, Kim E, et al., 2021, Effectiveness of Mobile Health-Based Exercise Interventions for Patients with Peripheral Artery Disease: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth, 9(2): e24080.
[24] Golledge J, Singh T, Alahakoon C, et al., 2019, Meta-Analysis of Clinical Trials Examining the Benefit of Structured Home Exercise in Patients with Peripheral Artery Disease. Br J Surg, 106(4): 319–331.
[25] Golledge J, Maarij K, Moxon J, et al., 2018, Systematic Review and Meta-Analysis of Clinical Trials Examining the Benefit of Exercise Programmes Using Nordic Walking in Patients with Peripheral Artery Disease. Eur J Vasc Endovasc Surg, 56(4): 534–543.
[26] Klaphake S, Buettner S, Ultee K, et al., 2018, Combination of Endovascular Revascularization and Supervised Exercise Therapy for Intermittent Claudication: A Systematic Review and Meta-Analysis. J Cardiovasc Surg (Torino), 59(2): 150–157.
[27] Veiga C, Pedras S, Oliveira R, et al., 2022, A Systematic Review on Smartphone Use for Activity Monitoring During Exercise Therapy in Intermittent Claudication. J Vasc Surg, 76(6): 1734–1741.
[28] Adegbola A, Behrendt C, Zyriax B, et al., 2022, The Impact of Nutrition on the Development and Progression of Peripheral Artery Disease: A Systematic Review. Clin Nutr, 41(1): 49–70.
[29] Pymer S, Ibeggazene S, Palmer J, et al., 2021, An Updated Systematic Review and Meta-Analysis of Home-Based Exercise Programs for Individuals with Intermittent Claudication. J Vasc Surg, 74(6): 2076–2085.e20.
[30] Machado I, Sousa N, Paredes H, et al., 2020, Combined Aerobic and Resistance Exercise in Walking Performance of Patients with Intermittent Claudication: Systematic Review. Front Physiol, 10: 1538.
[31] Pymer S, Palmer J, Harwood A, et al., 2019, A Systematic Review of High-Intensity Interval Training as an Exercise Intervention for Intermittent Claudication. J Vasc Surg, 70(6): 2076–2087.
[32] Doss E, Popejoy L, 2023, Interventions to Prevent Readmissions in Hospitalized Peripheral Vascular Surgery Patients: A Systematic Review. Clin Nurs Res, 32(2): 423–432.
[33] Wan D, Li V, Banfield L, et al., 2022, Diet and Nutrition in Peripheral Artery Disease: A Systematic Review. Can J Cardiol, 38(5): 672–680.
[34] Abaraogu U, Ezenwankwo E, Dall P, et al., 2018, Living a Burdensome and Demanding Life: A Qualitative Systematic Review of the Patients’ Experiences of Peripheral Arterial Disease. PloS One, 13(11): e0207456.
[35] Abaraogu U, Ezenwankwo E, Dall P, et al., 2018, Barriers and Enablers to Walking in Individuals with Intermittent Claudication: A Systematic Review to Conceptualize a Relevant and Patient-Centered Program. PloS One, 13(7): e0201095.
[36] Rezvani F, Heider D, König H, et al., 2024, Telephone Health Coaching and Remote Exercise Monitoring (TeGeCoach) in Peripheral Arterial Occlusive Disease—A Randomized Controlled Trial. Dtsch Arztebl Int, 121(10): 323–330.
[37] Lin M, Fu T, Hsu C, et al., 2021, Cycling Exercise Training Enhances Platelet Mitochondrial Bioenergetics in Patients with Peripheral Arterial Disease: A Randomized Controlled Trial. Thromb Haemost, 121(7): 900–912.
[38] Girold S, Rousseau J, Le Gal M, et al., 2017, Nordic Walking Versus Walking Without Poles for Rehabilitation with Cardiovascular Disease: Randomized Controlled Trial. Ann Phys Rehabil Med, 60(4): 223–229.
[39] Saratzis A, Paraskevaopoulos I, Patel S, et al., 2019, Supervised Exercise Therapy and Revascularization for Intermittent Claudication: Network Meta-Analysis of Randomized Controlled Trials. JACC Cardiovasc Interv, 12(12): 1125–1136.
[40] Harwood A, Broadbent E, Totty J, et al., 2017, “Intermittent Claudication a Real Pain in the Calf”—Patient Experience of Diagnosis and Treatment with a Supervised Exercise Program. J Vasc Nurs, 35(3): 131–135.
[41] Mazzolai L, Belch J, Venermo M, et al., 2024, Exercise Therapy for Chronic Symptomatic Peripheral Artery Disease: A Clinical Consensus Document of the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases in Collaboration with the European Society of Vascular Medicine and the European Society for Vascular Surgery. Eur Heart J, 45(15): 1303–1321.
[42] Agnelli G, Belch J, Baumgartner I, et al., 2020, Morbidity and Mortality Associated with Atherosclerotic Peripheral Artery Disease: A Systematic Review. Atherosclerosis, 293: 94–100.
[43] Escobar C, Barrios V, Cosín J, et al., 2021, SGLT2 Inhibitors and GLP1 Agonists Administered Without Metformin Compared to Other Glucose-Lowering Drugs in Patients with Type 2 Diabetes Mellitus to Prevent Cardiovascular Events: A Systematic Review. Diabet Med, 38(3): e14502.
[44] Ramirez J, Drudi L, Grenon S, 2018, Review of Biologic and Behavioral Risk Factors Linking Depression and Peripheral Artery Disease. Vasc Med, 23(5): 478–488.
