Predictors of Change in Walking Distance in Patients with Peripheral Arterial Disease Undergoing Endovascular Intervention

Abstract Introduction Guideline recommendations for antithrombotic (antiplatelet and anticoagulant) therapy during and after endovascular intervention are patchy and conflicted, in part due to a lack of evidence. The aim of this systematic review was to examine the antithrombotic specifications in randomised trials for peripheral arterial endovascular intervention. Method This review was conducted according to PRISMA guidelines. Randomised trials including participants with peripheral arterial disease undergoing endovascular arterial intervention were included. Trial methods were assessed to determine whether an antithrombotic protocol had been specified, its completeness, and the agent(s) prescribed. Antithrombotic protocols were classed as periprocedural (preceding/during intervention), immediate postprocedural (up to 14 days following intervention) and maintenance postprocedural (therapy continuing beyond 14 days). Trials were stratified according to type of intervention. Result Ninety-four trials were included. Only 29% of trials had complete periprocedural antithrombotic protocols, and 34% had complete post-procedural protocols. In total, 64 different periprocedural protocols, and 51 separate postprocedural protocols were specified. Antiplatelet monotherapy and unfractionated heparin were the most common choices of regimen in the periprocedural setting, and dual antiplatelet therapy (55%) was most commonly utilised postprocedure. There is an increasing tendency to use dual antiplatelet therapy with time or for drug-coated technologies. Conclusion Randomised trials comparing different types of peripheral endovascular arterial intervention have a high level of heterogeneity in their antithrombotic regimens, and there has been an increasing tendency to use dual antiplatelet therapy over time. Antiplatelet regimes need to be standardised in trials comparing endovascular technologies. Take-home message To determine the benefits of any endovascular intervention within a randomised trial, antithrombotic regimens should be standardised to prevent confounding. This systematic review demonstrates a high level of heterogeneity of antithrombotic prescribing in randomised trials of endovascular intervention, and an increasing tendency to utilise dual antiplatelet therapy, despite a lack of evidence of benefit, but an increased risk of harm.

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Patients with peripheral arterial disease show an ameliorated proinflammatory status over 12 months non-supervised exercise training parallel to an increased walking distance

European Heart Journal ◽

10.1093/eurheartj/eht310.p5819 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. P5819-P5819

Author(s):

J. F. Dopheide ◽

M. Scheer ◽

V. Obst ◽

C. Doppler ◽

M. P. Radsak ◽

...

Keyword(s):

Exercise Training ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Walking Distance ◽

Supervised Exercise ◽

Peripheral Arterial

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Incidence of Venous Thromboembolism in Patients With Peripheral Arterial Disease After Endovascular Intervention

Journal of Vascular Surgery ◽

10.1016/j.jvs.2021.11.025 ◽

2022 ◽

Vol 75 (1) ◽

pp. e29-e30

Author(s):

Daniel G. Kindell ◽

Emilie G. Duchesneau ◽

Sydney E. Browder ◽

Deanna Caruso ◽

Nathan T. Shenkute ◽

...

Keyword(s):

Venous Thromboembolism ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Endovascular Intervention ◽

Peripheral Arterial

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Heat therapy vs. supervised exercise therapy for peripheral arterial disease: a 12-wk randomized, controlled trial

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00151.2019 ◽

2019 ◽

Vol 316 (6) ◽

pp. H1495-H1506 ◽

Cited By ~ 10

Author(s):

Ashley P. Akerman ◽

Kate N. Thomas ◽

Andre M. van Rij ◽

E. Dianne Body ◽

Mesfer Alfadhel ◽

...

Keyword(s):

Blood Pressure ◽

Peripheral Arterial Disease ◽

Water Immersion ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Hot Water ◽

Walking Distance ◽

Supervised Exercise ◽

Heat Therapy ◽

Peripheral Arterial

Peripheral arterial disease (PAD) is characterized by lower limb atherosclerosis impairing blood supply and causing walking-induced leg pain or claudication. Adherence to traditional exercise training programs is poor due to these symptoms despite exercise being a mainstay of conservative treatment. Heat therapy improves many cardiovascular health outcomes, so this study tested if this was a viable alternative cardiovascular therapy for PAD patients. Volunteers with PAD were randomized to 12 wk of heat ( n = 11; mean age 76 ± 8 yr, BMI 28.7 ± 3.5 kg/m2, 4 females) or exercise ( n = 11; 74 ± 10 yr, 28.5 ± 6.8 kg/m2, 3 females). Heat involved spa bathing at ∼39°C, 3–5 days/wk for ≤30 min, followed by ≤30 min of callisthenics. Exercise involved ≤90 min of supervised walking and gym-based exercise, 1–2 days/wk. Following the interventions, total walking distance during a 6-min walk test increased (from ∼350 m) by 41 m (95% CI: [13, 69], P = 0.006) regardless of group, and pain-free walking distance increased (from ∼170 m) by 43 m ([22, 63], P < 0.001). Systolic blood pressure was reduced more following heat (−7 mmHg, [−4, −10], P < 0.001) than following exercise (−3 mmHg, [0, −6], P = 0.078), and diastolic and mean arterial pressure decreased by 4 mmHg in both groups ( P = 0.002). There were no significant changes in blood volume, ankle-brachial index, or measures of vascular health. There were no differences in the improvement in functional or blood pressure outcomes between heat and exercise in individuals with PAD. NEW & NOTEWORTHY Heat therapy via hot-water immersion and supervised exercise both improved walking distance and resting blood pressure in peripheral arterial disease (PAD) patients over 12 wk. Adherence to heat therapy was excellent, and the heat intervention was well tolerated. The results of the current study indicate that heat therapy can improve functional ability and has potential as an effective cardiovascular conditioning tool for individuals with PAD. Listen to this article's corresponding podcast at https://ajpheart.podbean.com/e/heat-therapy-vs-exercise-in-peripheral-arterial-disease/ .

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