Abstract 4371727: A systematic review and meta-analysis comparing the effect of remote ischemic preconditioning on patients with intermittent claudication

Introduction: remote ischemic preconditioning has been shown to enhance skeletal muscle resistance to ischemia. This type of ischemia is a key contributor to intermittent claudication in patients with peripheral arterial disease, a condition with limited therapeutic and interventional options. Accordingly, we conducted a meta-analysis to investigate the effects of remote ischemic preconditioning in patients presenting with claudication symptoms. Objectives: our objective was to perform a systematic review and meta-analysis comparing the improvement of symptoms related to intermittent claudication associated with peripheral arterial disease in patients undergoing remote ischemic preconditioning therapy versus placebo or absence of remote ischemic preconditioning. Methods: we conducted a search in the MEDLINE, Embase, and Cochrane databases from their inception to April 2025 for original, strictly randomized articles comparing remote ischemic preconditioning and placebo (or absence of remote ischemic preconditioning) in patients with peripheral arterial disease and intermittent claudication, classified by one or more of the following criteria: Ankle-Brachial Index ≤ 0.9; Rutherford stages I, II, or III; Fontaine stages IIA or IIB. The outcomes assessed included the increase in pain-free walking distance and the increase in maximum walking distance. Statistical analysis was performed using Review Manager 5.4 (Cochrane Collaboration). Results: we included 160 patients from 4 studies, all of which were randomized clinical trials. Remote ischemic preconditioning therapy was used in 82 (51.25%) patients. The follow-up duration of the studies ranged from 7 to 28 days. The mean age of patients was 63.9 ± 8.4 years, with a mean ankle-brachial index of 0.62 ± 0.1. Pain-free walking distance (MD 18.15; 95% CI 12.26–24.04; p < 0.00001; I2 = 0%) significantly increased in patients treated with remote ischemic preconditioning compared to placebo or no remote ischemic preconditioning. However, maximum walking distance (MD -4.28; 95% CI -55.34–46.77; p = 0.87; I2 = 49%) showed no superiority in the remote ischemic preconditioning group. Conclusion: this meta-analysis, comparing 160 patients from 4 RCTs, demonstrated that short-term remote ischemic preconditioning therapy in patients with intermittent claudication is associated with increased pain-free walking distance compared to the control group.