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Lack of functional benefits following infrainguinal bypass in peripheral arterial occlusive disease patients

Claude D Pepper Older Americans Independence Center, Department of Medicine, Division of Gerontology, University of Maryland, Baltimore, and Geriatric Research, Education and Clinical Center, Maryland Veterans Affairs Health Care System at Baltimore, MD, USA, gardnerKgrecc.umaryland.edu

Lois A Killewich

Section of Vascular Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA

This study aimed to determine whether peripheral arterial occlusive disease (PAOD) patients with critical limb-threatening ischemia experienced functional benefits following lower extremity revascularization. Twenty ambulatory patients (aged 68 - 7 years) underwent infrainguinal revascularization to alleviate their symptoms. Peripheral hemodynamic and functional measures were obtained on each patient 1 week prior to and 3-4 months following revascularization. Critical limb-threatening ischemia was alleviated by surgery in all patients because the ankle/brachial index (ABI) increased 133% (p, 0.001) from 0.33 6 0.06 to 0.77 6 0.09. Despite the marked peripheral hemodynamic improvement following revascularization, little gains were noted in functional measures. The 6-min walking distance was unchanged (p = 0.739) from 85 6 9 m to 101 6 11 m. Additionally, the free-living daily physical activity, measured by an accelerometer worn over a 2-day period, was unchanged (p = 0.996) from 214 6 46 kcal/day to 215 6 83 kcal/day. In contrast, self-perceived ambulatory function improved by 142% to 271% (p, 0.001), and self-perceived physical activity increased 134% to 156% (p, 0.001). In conclusion, limb salvage following infrainguinal bypass does not translate into improvements in measured ambulation or in measured physical activity in PAOD patients, even though the patients perceive these measures to be better.

Key Words: ambulation • critical limb-threatening ischemia • intermittent claudication • physical activity • revascularization

Vascular Medicine, Vol. 6, No. 1, 9-14 (2001)
DOI: 10.1177/1358836X0100600103


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