Extracorporeal shock wave therapy for peripheral arterial disease-related intermittent claudication: a systematic review and meta-analysis

Abstract

Background Intermittent claudication (IC) is a common manifestation of peripheral arterial disease. This study evaluates the efficacy of extracorporeal shock wave therapy (ESWT), a non-invasive treatment, for patients with IC.Methods A systematic review and meta-analysis of four major databases (PubMed, Embase, Cochrane Library, Web of Science) was conducted through March 2025. Eight studies met inclusion criteria for the analysis, which was performed using Review Manager 5.4 with evidence strength assessed by the GRADE system.Results The analysis included eight studies with a total of 332 patients (mean age >50 years, 67.5% male). Compared to placebo, ESWT demonstrated significant improvements in functional outcomes. It led to substantial increases in both Pain-Free Walking Distance (MD=26.53, p < 0.01) and Maximum Walking Distance (MD=37.21, p < 0.01). Quality of life was also enhanced, reflected by higher scores on the EQ-5D-3L survey (MD=0.08, p < 0.01) and improvements across SF-36 domains including Physical Function, General Health, Vitality, and Social Functioning. However, ESWT did not produce a significant change in the Ankle-Brachial Index (ABI) (MD=−0.01, p = 0.05).Conclusion ESWT is associated with improved walking distance and quality of life in patients with IC. These findings require cautious interpretation due to the limited number of studies and small sample sizes.Clinical trial number Not applicable.

Keywords

• Extracorporeal shock wave therapy
• intermittent claudication
• meta-analysis
• systematic review