Remote ischemic preconditioning in the management of intermittent claudication: a pilot randomized controlled trial.

OBJECTIVE: To evaluate Remote ischaemic preconditioning in management of intermittent claudication patients BACKGROUND: Animal data suggest that remote ischaemic conditioning (RIC) can improve blood flow in ischaemic limbs and, consequently, may benefit claudication patients Supervised exercise is the preferred first-line intervention for patients with intermittent claudication (IC) but is constrained by limited availability and logistical issues, particularly in rural settings METHODS: We undertook a randomised clinical trial to evaluate RIC's effect in claudication patients. Stable IC patients were randomly allocated to receive RIC alone, structured resistance exercise (SE) alone, RIC plus SE or to a control group which received standard advice and risk factor modification. Patients received their intervention over a 28-day period. RIC patients attended an RIC clinic every 3 to 4 days to undergo 4 cycles of 5 minutes upper limb ischaemia followed by 5 minutes reperfusion induced with a standard blood pressure cuff.

RESULTS: 45 patients were randomised, of whom 40 completed the trial (10 patients per group). The RIC alone, SE alone and RIC plus SE groups all demonstrated significant improvements in pain-free walking distance and ankle-brachial pressure indices at 30 days. There were no differences in the magnitude of improvements between the groups.

CONCLUSION: Compare with standard care RIC is promising as a home-delivered intervention. It appears to be equivalent to SE in the treatment of IC. with no apparent additive benefit to combining the two interventions in this small size sample. large scale RCT is needed for validation.