Functional Benefits of Peripheral Vascular Bypass Surgery for Patients with Intermittent Claudication

Abstract

Many patients with peripheral arterial disease (PAD) undergo peripheral bypass surgery to relieve the symptom of intermittent claudication. However, measurement of graft patency alone, assessed by change in ankle blood pressure, may not adequately reflect the improvement in functional status following the operation. Fourteen patients with moderately severe intermittent claudication were evaluated before and after bypass surgery to asses changes in hemodynamics (by resting ankle-brachial indices-ABIs), exercise performance (by a graded treadmill protocol), and community-based walking ability (by a questionnaire that characterizes self-reported walking speed and distance). Six weeks after surgery, resting ABIs improved in surgical patients (from 0.56 +/- 0.09 to 0.93 +/- 0.16, P < 0.05). Peak treadmill walking time improved from 6.2 +/- 5.9 to 11.8 +/- 7.1 min (90%), peak oxygen consumption from 15.5 +/- 6.5 to 19.1 +/- 8.5 mL/kg/min (23%), and pain-free walking time from 1.5 +/- 0.4 to 6.0 5.5 min (290%). Questionnaire scores for walking distance improved by 203% and for walking speed by 130% (all P < 0.05). After twelve weeks, improvements other than pain-free walking time were maintained. Changes in peak treadmill performance or questionnaire scores were not correlated with the initial ABI, changes in ABI six or twelve weeks after surgery, or the type or extent of bypass surgery. The results demonstrate that surgical treatment of PAD, indicated for the relief of intermittent claudication, improves exercise performance and self-reported community-based walking ability. The change in functional status of the patient is an important outcome of surgery that cannot be predicted from routine noninvasive testing alone and should be measured directly.

Ankle-brachial index and physical function in older individuals: The Atherosclerosis Risk in Communities (ARIC) study

“…31, 41 Thus, it would be of interest to include the impact on physical function in this discussion. Indeed, identification of PAD as a cause of impaired lower-extremity physical function may have therapeutic implications since several studies have demonstrated that lifestyle (e.g., smoking cessation 42 or exercise 43 ) or medical (e.g., cilostazol 44 or revascularization 45, 46 ) interventions may improve physical function among patients with PAD and leg symptoms. This is particularly relevant to older adults since lower extremity performance is an important predictor to sustain their independent living.…”

Mitochondrial Bioenergetics in the Metabolic Myopathy Accompanying Peripheral Artery Disease

“…Indeed, revascularization of occluded blood vessels does not fully restore the muscle functional limitations in PAD patients (Regensteiner et al, 1993a; Gardner and Killewich, 2001; West et al, 2012), while exercise treatment improves functional capacity with negligible (Larsen and Lassen, 1966; Sorlie and Myhre, 1978) to modest increases in leg blood flow (Hiatt et al, 1990). These findings indicate that additional factors besides hemodynamic limitations contribute to the pathophysiology of the functional impairment in PAD.…”

The ankle-brachial index is associated with the magnitude of impaired walking endurance among men and women with peripheral arterial disease

“…6–9 These prior studies included relatively small sample sizes and included only participants with classic intermittent claudication symptoms. 6–9 Including only PAD participants with classic intermittent claudication symptoms is an important limitation because most men and women with PAD do not have symptoms of intermittent claudication. 4,5,10 Some PAD patients without classic intermittent claudication have greater functional impairment than PAD participants with intermittent claudication.…”