Arterial Prehabilitation

Abstract

Coronary angiography and angioplasty are common invasive procedures in cardiovascular medicine, which involve placement of a sheath inside peripheral conduit arteries. Sheath placement and catheterization can be associated with arterial thrombosis, spasm and occlusion. In this paper we review the literature pertaining to the possible benefits of arterial 'prehabilitation'--the concept that interventions aimed at enhancing arterial function and size (i.e. remodelling) should be undertaken prior to cardiac catheterization or artery harvest during bypass graft surgery. The incidence of artery spasm, occlusion and damage is lower in larger arteries with preserved endothelial function. We conclude that the beneficial effects of exercise training on both artery size and function, which are particularly evident in individuals who possess cardiovascular diseases or risk factors, infer that exercise training may reduce complication rates following catheterization and enhance the success of arteries harvested as bypass grafts. Future research efforts should focus directly on examination of the 'prehabilitation' hypothesis and the efficacy of different interventions aimed at reducing clinical complications of common interventional procedures.

Impact of catheterization on shear-mediated arterial dilation in healthy young men

“…From a clinical perspective, it has been hypothesized that optimizing the function and size of arteries prior to catheterization may limit the impact of transradial catheterization and improve arterial health post-procedure. As such, preoperative exercise-based rehabilitation has been suggested prior to transradial catheterization (Alkarmi et al 2010 ), due to the well-established benefits of exercise training on arterial function and outward remodelling (Hambrecht et al 2004 ; Green et al 2017 ; Dawson et al 2012 ; Conraads et al 2015 ). Although our current data in fit healthy young subjects indicate that preoperative exercise-based rehabilitation is unlikely to fully negate the impact of catheterization on arterial function, the well-established benefits of exercise training on artery function, structure and health should not be discounted (Green et al 2017 ).…”

Comparing Frailty Markers in Predicting Poor Outcomes after Transcatheter Aortic Valve Replacement

“…43,44 The postoperative management of TAVR patients can range from 24 hours of observation to stays in the intensive care unit depending on the acuity of the patient and complications associated with the procedure, and long-term follow-up is provider dependent. 41 We propose that sarcopenia of the psoas muscles and albumin levels may play a role in determining how much individualized, patient-centered care may be of benefit for patients undergoing TAVR. Further, multi-institutional studies and external validation are necessary to determine the utility of these markers in determining candidacy for TAVR and assigning specific perioperative treatments or therapies to address frailty.…”

Effects of Catheterization on Artery Function and Health: When Should Patients Start Exercising Following Their Coronary Intervention?

“…Such benefits have been summarized in a recent review [47]. These effects would be expected to enhance the recovery from catheter related injury, but there is scant evidence regarding the most appropriate time to begin a preventive exercise program, or indeed whether pre-rehabilitation prior to catheterization maybe be as beneficial as post hoc training to enhance recovery [192]. Despite the evidence supporting that exercise-based CR benefits the event-free survival of patients post coronary interventions, the participation rate in both Europe and United States is far lower than desirable; approximately one-third of patients participate in cardiac rehab programs after a cardiac event [193][194][195][196].…”