This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Regensteiner, J. G. Articles by Hiatt, W. R. Search for Related Content PubMed Articles by Regensteiner, J. G. Articles by Hiatt, W. R. Social Bookmarking                         What's this?

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

Department of Medicine, Section of Vascular Medicine, and the Department of Surgery, Section of Vascular Surgery, University of Colorado School of Medicine, Denver, Colorado

Melanie E. Hargarten

Department of Medicine, Section of Vascular Medicine, and the Department of Surgery, Section of Vascular Surgery, University of Colorado School of Medicine, Denver, Colorado

Robert B. Rutherford

Department of Medicine, Section of Vascular Medicine, and the Department of Surgery, Section of Vascular Surgery, University of Colorado School of Medicine, Denver, Colorado

William R. Hiatt

Department of Medicine, Section of Vascular Medicine, and the Department of Surgery, Section of Vascular Surgery, University of Colorado School of Medicine, Denver, Colorado

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 pres sure, may not adequately reflect the improvement in functional status following the operation. Fourteen patients with moderately severe intermittent claudica tion were evaluated before and after bypass surgery to assess changes in hemo dynamics (by resting ankle-brachial indices-ABIs), exercise performance (by a graded treadmill protocol), and community-based walking ability (by a ques tionnaire 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, improve ments other than pain-free walking time were maintained. Changes in peak treadmill performance or questionnaire scores were not correlated with the ini tial 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, indi cated 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 pre dicted from routine noninvasive testing alone and should be measured directly.

Vascular and Endovascular Surgery, Vol. 27, No. 6, 437-446 (1993)
DOI: 10.1177/153857449302700604


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?