Correspondence (letters to the editor): More Amputations with Intervention

Rümenapf et al. point out the value of supervised walking (standardized exercise = [SET]) very well in their article (1). In the conclusion, they state: “It would be desirable for SET to be more available and more widely used, both to sustain the benefit of revascularization over the long term and to lower the general cardiovascular risk.” With this, the authors already point to the dangers of revascularization in the stage of intermittent claudication (IC).

The risk of amputation of 0.4% per year cited by the authors only applies to patients who have not been revascularized. After revascularization, the rate of amputation and death increases to 4.3% annually in patients with IC (2). The periprocedural mortality for inpatients in the IC stage is 1.9% (3).

In their discussion, the authors justifiably state that the optimal functional results can be achieved through the combination of SET and revascularization. Against this background, the question arises as to whether an intervention in the claudication stage should be carried out at all if no SET can be offered. The task of a group of experts whose research is based on working towards a guideline should aim at optimal treatment approaches instead of justifying the imperfect treatment reality.