Long-term outcomes of supervised exercise in peripheral artery disease: Impact of differing modes of exercise 1–4 years after intervention

2018 ◽  
Vol 36 (3) ◽  
pp. 121-128 ◽  
Author(s):  
Laura N. Kirk ◽  
Rebecca Brown ◽  
Diane Treat-Jacobson
Keyword(s):  
Peripheral Artery Disease ◽  
Peripheral Artery ◽  
Long Term Outcomes ◽  
Supervised Exercise ◽  
Disease Impact ◽  
Artery Disease

Long-term outcomes following endovascular and surgical revascularization for peripheral artery disease: a propensity score-matched analysis

2021 ◽  
Author(s):  
Saman L Parvar ◽  
Linh Ngo ◽  
Joseph Dawson ◽  
Stephen J Nicholls ◽  
Robert Fitridge ◽  
...  
Keyword(s):  
Propensity Score ◽  
Peripheral Artery Disease ◽  
Limb Ischaemia ◽  
Peripheral Artery ◽  
Long Term Outcomes ◽  
Surgical Revascularization ◽  
Endovascular Revascularization ◽  
Acute Limb Ischaemia ◽  
Artery Disease

Abstract Aims Peripheral artery disease (PAD) revascularization can be performed by either endovascular or open surgical approach. Despite increasing use of endovascular revascularization, it is still uncertain which strategy yields better long-term outcomes. Methods and results This retrospective cohort study evaluated patients hospitalized with PAD in Australia and New Zealand who underwent either endovascular or surgical revascularization between 2008 and 2015, and compared procedures using a propensity score-matched analysis. Hybrid interventions were excluded. The primary endpoint was mortality or major adverse limb events (MALE), defined as a composite endpoint of acute limb ischaemia, urgent surgical or endovascular reintervention, or major amputation, up to 8 years post-hospitalization using time-to-event analyses 75 189 patients fulfilled eligibility (15 239 surgery and 59 950 endovascular), from whom 14 339 matched pairs (mean ± SD age 71 ± 12 years, 73% male) with good covariate balance were identified. Endovascular revascularization was associated with an increase in combined MALE or mortality [hazard ratio (HR) 1.13, 95% confidence interval (CI): 1.09–1.17, P < 0.001]. There was a similar risk of MALE (HR 1.04, 95% CI: 0.99–1.10, P = 0.15), and all-cause urgent rehospitalizations (HR 1.01, 95% CI: 0.98–1.04, P = 0.57), but higher mortality (HR 1.16, 95% CI: 1.11–1.21, P < 0.001) when endovascular repair was compared to surgery. In subgroup analysis, these findings were consistent for both claudication and chronic limb-threatening ischaemia presentations. Conclusion Although the long-term risk of MALE was comparable for both approaches, enduring advantages of surgical revascularization included lower long-term mortality. This is at odds with some prior PAD studies and highlights contention in this space.

scholarly journals TCT-803 Long term outcomes in diabetic patients treated with atherectomy for peripheral artery disease

2016 ◽  
Vol 68 (18) ◽  
pp. B325
Author(s):  
Adam Janas ◽  
Piotr Buszman ◽  
Krzysztof Milewski ◽  
Marek Król ◽  
Wojciech Fil ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Diabetic Patients ◽  
Peripheral Artery ◽  
Long Term Outcomes ◽  
Artery Disease

scholarly journals Comparison of long-term outcomes after directional versus rotational atherectomy in peripheral artery disease

2020 ◽  
Vol 16 (1) ◽  
pp. 76-81
Author(s):  
Adam Janas ◽  
Krzysztof Milewski ◽  
Piotr Buszman ◽  
Aleksandra Kolarczyk-Haczyk ◽  
Wojciech Trendel ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Rotational Atherectomy ◽  
Peripheral Artery ◽  
Long Term Outcomes ◽  
Artery Disease

scholarly journals Long term outcomes in diabetic patients treated with atherectomy for peripheral artery disease

2013 ◽  
Author(s):  
Adam J. Janas ◽  
Krzysztof P. Milewski ◽  
Piotr P. Buszman ◽  
Wojciech Trendel ◽  
Aleksandra Kolarczyk-Haczyk ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Diabetic Patients ◽  
Peripheral Artery ◽  
Long Term Outcomes ◽  
Artery Disease

scholarly journals Outcomes after peripheral artery disease intervention among Medicare–Medicaid dual-eligible patients compared with the general medicare population in the Vascular Quality Initiative registry

2019 ◽  
Vol 1 (1) ◽  
pp. e000018
Author(s):  
Andrea M Austin ◽  
Gouri Chakraborti ◽  
Jesse Columbo ◽  
Niveditta Ramkumar ◽  
Kayla Moore ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Safety Net ◽  
Critical Limb Ischaemia ◽  
Peripheral Artery ◽  
Long Term Outcomes ◽  
Vascular Intervention ◽  
Postoperative Imaging ◽  
Dual Eligible ◽  
Artery Disease

ObjectiveTo determine whether patients from the Vascular Quality Initiative (VQI) registry who are Medicare–Medicaid dual-eligible have outcomes after surgical intervention with medical devices such as stents for peripheral artery disease comparable to the outcomes of those eligible for Medicare alone.MethodsThe study cohort included fee-for-service Medicare beneficiaries from 2010 to 2015 who underwent peripheral vascular intervention as determined by the VQI. We performed propensity matching between the dual-eligible and non-dual-eligible cohorts. Postintervention use, including imaging, amputation and death, was determined using Medicare claims data.ResultsRates of major amputation were higher among dual-eligible patients (13.0% vs 10.5%, p<0.001), while time to amputation by disease severity was similar (p=0.443). For patients with more advanced disease (critical limb ischaemia (CLI) vs claudication), dual-eligible patients have significantly faster times to any amputation and death (p<0.001). For of postoperative imaging, 48.4% of dual-eligible patients receive at least one postoperative image, while the percentage for non-dual-eligible patients is 47.2% (p=0.187).ConclusionsPatients with mild forms of peripheral artery disease (PAD), such as claudication, demonstrated similar outcomes regardless of dual-eligibility status. However, those with severe PAD, such as CLI, who were also dual-eligible had both inferior overall survival and amputation-free survival. Minimal differences were observed in process-driven aspects of care between dual-eligible and non-dual-eligible patients, including postoperative imaging. These findings indicate that despite receiving similar care, dual-eligible patients with severe PAD have inferior long-term outcomes, suggesting the Medicaid safety net is not timely enough to benefit from long-term outcomes for these patients.

scholarly journals Multimodal Supervised Exercise Training is Effective in Improving Long Term Walking Performance in Patients with Symptomatic Lower Extremity Peripheral Artery Disease

2021 ◽  
Vol 10 (10) ◽  
pp. 2057
Author(s):  
Barbara Ney ◽  
Stefano Lanzi ◽  
Luca Calanca ◽  
Lucia Mazzolai
Keyword(s):  
Exercise Training ◽  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
Walking Distance ◽  
Peripheral Artery ◽  
Supervised Exercise ◽  
Walking Performance ◽  
Artery Disease ◽  
Fontaine Stage

This study aimed to evaluate the effect of a multimodal supervised exercise training (SET) program on walking performance for 12 months in patients with symptomatic lower extremity peripheral artery disease (PAD). Consecutive patients with Fontaine stage II PAD participating in the SET program of our hospital were retrospectively investigated. Walking performance, assessed using a treadmill with measures of the pain-free and maximal walking distance (PFWD, MWD, respectively), and 6 min walking distance (6MWD), were tested before and following SET, as well as at 6 and 12 months after SET completion. Ninety-three symptomatic patients with PAD (65.0 ± 1.1 y) were included in the study. Following SET, the walking performance significantly improved (PFWD: +145%, p ≤ 0.001; MWD: +97%, p ≤ 0.001; 6MWD: +15%, p ≤ 0.001). At 6 months, PFWD (+257%, p ≤ 0.001), MWD (+132%, p ≤ 0.001), and 6MWD (+11%, p ≤ 0.001) remained significantly improved compared with the pre-SET condition. At 12 months, PFWD (+272%, p ≤ 0.001), MWD (+130%, p ≤ 0.001), and 6MWD (+11%, p ≤ 0.001) remained significantly improved compared with the pre-training condition. The walking performance remained significantly improved in both women and men for up to 12 months (p ≤ 0.001). Multimodal SET is effective at improving walking performance in symptomatic patients with PAD, with improvements lasting up to 12 months.

Individual Differences in Response to Supervised Exercise Therapy for Peripheral Artery Disease

2020 ◽  
pp. 019394592097747
Author(s):  
Mary O. Whipple ◽  
Erica N. Schorr ◽  
Kristine M.C. Talley ◽  
Julian Wolfson ◽  
Ruth Lindquist ◽  
...  
Keyword(s):  
Older Adults ◽  
Peripheral Artery Disease ◽  
Exercise Therapy ◽  
Poor Response ◽  
Walking Distance ◽  
Peripheral Artery ◽  
Meaningful Improvement ◽  
Supervised Exercise ◽  
Patient Reported ◽  
Artery Disease

Nonresponse to exercise has been extensively examined in young athletes but is seldom reported in studies of aerobic exercise interventions in older adults. This study examined the prevalence of nonresponse and poor response to exercise in functional and quality of life outcomes and response patterns between and among older adults undergoing 12-weeks of supervised exercise therapy for the management of peripheral artery disease ( N = 44, mean age 72.3 years, 47.7% female). The prevalence of nonresponse (no change/decline in performance) in walking distance was 31.8%. The prevalence of poor response (lack of a clinically meaningful improvement) was 43.2%. Similar patterns of response were observed in both objective and patient-reported measures of physical function. All participants improved in at least one outcome; only two participants improved in all measured outcomes. Additional research should examine modifiable predictors of response to inform programming and maximize an individual’s potential benefit from exercise therapy.

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