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Revasularisation in peripheral arterial disease: effect on leg blood flow, walking tolerance and calf muscle function
Abstract   Peer reviewed

Revasularisation in peripheral arterial disease: effect on leg blood flow, walking tolerance and calf muscle function

Brad Stefanovic, Fraser D Russell, P J Walker, S Green and Christopher D Askew
17th Annual Congress of the European College of Sports Science Book of Abstracts, p.88
Annual Congress of the European College of Sports Science (ECSS), 17th (Bruges, Belgium, 04-Jul-2012–07-Jul-2012)
2012
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Abstract

Human Movement and Sports Science
Introduction Haemodynamic and nonhaemodynamic factors are believed to contribute to walking intolerance in patients with PAD. Whilst revascularisation leads to improvements in walking tolerance, the mechanisms of improvement and its influence on calf muscle function are not clear. This study aimed to determine the effect of revascularisation on walking tolerance, calf muscle function and leg blood flow in PAD. Methods 12 men and 3 women (age 63 +/- 8 y) with PAD scheduled to undergo revascularisation were included. Resting ankle to brachial index (ABI) of the limb to be revascularised (VASC) was 0.72 +/- 0.11 compared to 0.95±0.19 for the non revascularised limb (NON-VASC). Before and 2-4 weeks after revascularisation, six minute walking distance (6MWD) was assessed, as was calf muscle strength, endurance, and fatigue using an isometric plantar flexion dynamometer in both VASC and NON-VASC limbs. Leg blood flow was measured during calf exercise using strain gauge plethysmography. The biphasic responses of the muscle blood flow and fatigue responses were quantified by fitting distinct equations to these data. Results Revascularisation lead to a non-significant increase in 6MWD (pre 352 +/- 90; post 408 +/- 77 m, p = 0.07). There was an increase in ABI for VASC (pre 0.72 +/- 0.11; post 1.05 +/- 0.22) compared with NON-VASC limbs (pre 0.96 +/- 0.17; post 1.00 +/- 0.21). Exercise blood flow magnitude increased (pre 26.2 +/- 11.7; post 38.1 +/- 13.9 ml.100ml-1.min-1) in the VASC limbs, and there was an increased amplitude for both the early and late phases of the exercise blood flow response. The time delay preceding the late blood flow phase decreased in the VASC (pre 22.4 +/- 13.3; post 15.4 +/- 6.2 s) compared with the NON-VASC limbs (pre 14.4 +/- 6.5; post 17.4 +/- 8.5 s). Muscle endurance, but not strength, was increased in VASC (pre 259 +/- 160; post 525 +/- 382 s) but not the NON-VASC limbs (pre 516 +/- 373; post 586 +/- 316 s). There were no significant changes in muscle fatigue, although there tended to be an increase in the time delay prior to the late fatigue phase for the revascularised limbs (VASC: pre 152 +/- 77; post 202 +/- 115. NONVASC: pre 221 +/- 129; post 207 +/- 139 s, p = 0.09). Discussion Revascularisation resulted in a significant improvement in exercise blood flow and plantar flexion endurance. These data support the notion that exercise blood flow is an important determinant of exercise capacity in PAD.

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