Peri-Operative Medicine

Claudication – surgery or exercise?

In this trial of 150 patients with intermittent claudication (baseline mean ABI 0.62), they were randomized to either exercise training or revascularization. At 6 and 12 months, there was no significant difference between the groups in maximum walking distance or quality of life scores, indicating that we should consult PT before vascular surgery in patients with intermittent claudication (abstract).

CABG still standard for 3V CAD

In this large multicenter randomized trial of almost 2000 patients with 3 vessel or left main CAD, patients were randomized to CABG or PCI. PCI was found to have higher rates of adverse cardiac and cerebrovascular events (18% vs 12%) at 12 months (primarily driven by repeat revascularization). Death and MI rates were similar, although CABG patients had a higher risk of stroke (2.2% vs 0.6%). For now, CABG should remain the standard for revascularization of patients with 3 vessel or Left main CAD (abstract)