Abstract
Background
Endovascular treatment of peripheral artery disease is becoming frequent, yet the clinical factors which predict ambulatory outcomes are not known.
Hypothesis
To identify predictors of change in walking distance in patients who underwent endovascular intervention for their lower extremity peripheral arterial disease (PAD).
Methods
A total of 134 patients underwent lower extremity peripheral arterial intervention, 52 patients were contacted via phone between 1 and 36 months (a mean of 22 mo) after their initial procedure. The remaining 82 patients were excluded due to the following reasons: death (n = 13), contact information was not available (n = 50), and refusal to participate in the follow‐up (n = 19).
Results
The patients were 63 ± 12 years old (mean ± standard deviation [SD]), 46% were male, 47% were diabetics, 49% had coronary artery disease, of whom 29% had prior revascularization, and 22% had coronary artery bypass grafts (CABG). The disease severity described by Fontaine classification were as follows: 44.2% were in stage II, 15.4% were in stage III, and 40.4% were in stage IV. Walking distance was improved in 21% of patients, worsened in 73% of patients, and unchanged in 6% of patients. Stepwise multiple regression demonstrated that patients who started to walk or exercise (R = 0.372, P < 0.012) and who had a prior history of CABG (R = 0.467, P < 0.006) were the only independent predictors of the change in walking distance at follow‐up. Those who started to walk reported worse walking distance at follow‐up, while those with a history of CABG reported better walking distance at follow‐up.
Conclusion
CABG prior to endovascular intervention is predictive of favorable change in walking distance in patients with PAD at follow‐up. Therefore, post‐CABG patients are good candidates for exercise rehabilitation and risk factor modification. Copyright © 2009 Wiley Periodicals, Inc.
Full Text
The Full Text of this article is available as a PDF (101.8 KB).
References
- 1. Criqui MH, Denenberg JO, Langer RD, Fronek A. The epidemiology of peripheral arterial disease: importance of identifying the population at risk. Vasc Med 1997; 2(3): 221–226. [DOI] [PubMed] [Google Scholar]
- 2. Goessens BM, van der Graaf Y, Olijhoek JK, Visseren FL. The course of vascular risk factors and the occurrence of vascular events in patients with symptomatic peripheral arterial disease. J Vasc Surg. Jan 2007; 45(1): 47–54. [DOI] [PubMed] [Google Scholar]
- 3. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; Trans Atlantic Inter‐Society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol 2006; 47(6): 1239–1312. [DOI] [PubMed] [Google Scholar]
- 4. Caro J, Migliaccio‐Walle K, Ishak KJ, Proskorovsky I. The morbidity and mortality following a diagnosis of peripheral arterial disease: long‐term follow‐up of a large database. BMC Cardiovasc Disord 2005; 5: 14. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Kudo T, Chandra FA, Kwun WH, Haas BT, Ahn SS. Changing pattern of surgical revascularization for critical limb ischemia over 12 years: endovascular vs open bypass surgery. J Vasc Surg 2006; 44(2): 304–313. [DOI] [PubMed] [Google Scholar]
- 6. Dotter CT, Judkins MP. Transluminal treatment of arteriosclerotic obstruction. Description of a new technic and a preliminary report of its application. 1964. Radiology 1989; 172(3 Pt 2): 904–920. [DOI] [PubMed] [Google Scholar]
- 7. Johnston KW. Factors that influence the outcome of aortoiliac and femoropopliteal percutaneous transluminal angioplasty. Surg Clin North Am 1992; 72(4): 843–850. [DOI] [PubMed] [Google Scholar]
- 8. Stanley B, Teague B, Raptis S, Taylor DJ, Berce M. Efficacy of balloon angioplasty of the superficial femoral artery and popliteal artery in the relief of leg ischemia. J Vasc Surg 1996; 23(4): 679–685. [DOI] [PubMed] [Google Scholar]
- 9. Hunink MG, Donaldson MC, Meyerovitz MF, et al. Risks and benefits of femoropopliteal percutaneous balloon angioplasty. J Vasc Surg 1993; 17(1): 183–192. [PubMed] [Google Scholar]
- 10. Krankenberg H, Schluter M, Steinkamp HJ, et al. Nitinol stent implantation versus percutaneous transluminal angioplasty in superficial femoral artery lesions up to 10 cm in length: the femoral artery stenting trial (FAST). Circulation 2007; 116(3): 285–292. [DOI] [PubMed] [Google Scholar]
- 11. Schillinger M, Sabeti S, Dick P, et al. Sustained benefit at 2 years of primary femoropopliteal stenting compared with balloon angioplasty with optional stenting. Circulation 2007; 115(21): 2745–2749. [DOI] [PubMed] [Google Scholar]
- 12. Schillinger M, Sabeti S, Loewe C, et al. Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery. N Engl J Med 2006; 354(18): 1879–1888. [DOI] [PubMed] [Google Scholar]
- 13. Adam DJ, Beard JD, Cleveland T, et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet 2005; 366(9501): 1925–1934. [DOI] [PubMed] [Google Scholar]
- 14. Yacyshyn VJ, Thatipelli MR, Lennon RJ, et al. Predictors of failure of endovascular therapy for peripheral arterial disease. Angiology 2006; 57(4): 403–417. [DOI] [PubMed] [Google Scholar]
- 15. Gardner AW, Montgomery PS. The Baltimore activity scale for intermittent claudication: a validation study. Vasc Endovascular Surg 2006; 40(5): 383–391. [DOI] [PubMed] [Google Scholar]
- 16. Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TASC Working Group. Trans Atlantic Inter‐Society Consensus (TASC). J Vasc Surg 2000; 31(1 Pt 2): S1–S296. [PubMed] [Google Scholar]
- 17. Hirschhorn AD, Richards D, Mungovan SF, Morris NR, Adams L. Supervised moderate intensity exercise improves distance walked at hospital discharge following coronary artery bypass graft surgery‐a randomised controlled trial. Heart Lung Circ 2008; 17(2): 129–138. [DOI] [PubMed] [Google Scholar]
- 18. Fiorina C, Vizzardi E, Lorusso R, et al. The 6− walking test early after cardiac surgery. Reference values and the effects of rehabilitation programme. Eur J Cardiothorac Surg 2007; 32(5): 724–729. [DOI] [PubMed] [Google Scholar]
- 19. Hedback B, Perk J, Hornblad M, Ohlsson U. Cardiac rehabilitation after coronary artery bypass surgery: 10‐year results on mortality, morbidity and readmissions to hospital. J Cardiovasc Risk 2001; 8(3): 153–158. [DOI] [PubMed] [Google Scholar]
- 20. WHO. The rehabilitation of patients with cardiovascular diseases. Report on a seminar. EURO 0381.Copenhagen: World Health Organization, regional office for Europe, Copenhagen; 1969.
- 21. Long‐term comprehensive care of cardiac patients. Recommendations by the Working Group on Rehabilitation of the European Society of Cardiology. Eur Heart J 1992; 13(suppl C): 1–45. [PubMed] [Google Scholar]
- 22. Opasich C, De Feo S, Pinna GD, et al. Distance walked in the 6‐minute test soon after cardiac surgery: toward an efficient use in the individual patient. Chest 2004; 126(6): 1796–1801. [DOI] [PubMed] [Google Scholar]
- 23. Leng GC, Fowler B, Ernst E. Exercise for intermittent claudication. Cochrane Database Syst Rev. 2000(2): CD000990. [DOI] [PubMed] [Google Scholar]
- 24. Gardner AW, Poehlman ET. Exercise rehabilitation programs for the treatment of claudication pain. A meta‐analysis. JAMA 1995; 274(12): 975–980. [PubMed] [Google Scholar]
- 25. Strandness DE Jr, Dalman RL, Panian S, et al. Effect of cilostazol in patients with intermittent claudication: a randomized, double‐blind, placebo‐controlled study. Vasc Endovascular Surg 2002; 36(2): 83–91. [DOI] [PubMed] [Google Scholar]
- 26. Aronow WS, Nayak D, Woodworth S, Ahn C. Effect of simvastatin versus placebo on treadmill exercise time until the onset of intermittent claudication in older patients with peripheral arterial disease at six months and at one year after treatment. Am J Cardiol 2003; 92(6): 711–712. [DOI] [PubMed] [Google Scholar]
- 27. Mohler ER III, Hiatt WR, Creager MA. Cholesterol reduction with atorvastatin improves walking distance in patients with peripheral arterial disease. Circulation 2003; 108(12): 1481–1486. [DOI] [PubMed] [Google Scholar]
- 28. Mondillo S, Ballo P, Barbati R, et al. Effects of simvastatin on walking performance and symptoms of intermittent claudication in hypercholesterolemic patients with peripheral vascular disease. Am J Med 2003; 114(5): 359–364. [DOI] [PubMed] [Google Scholar]