Ankle-brachial index in patients with intermittent claudication is a poor indicator of patient-centered and clinician-based evaluations of functional status

Background: This study assessed the relationship between lower limb hemodynamics and metabolic parameters with walking tolerance in patients with intermittent claudication (IC). Patients and methods: Resting ankle-brachial index (ABI), baseline blood flow (BF), BF response to reactive hyperemia (BFRH), oxygen uptake (VO2), initial claudication distance (ICD) and total walking distance (TWD) were measured in 28 IC patients. Pearson and Spearman correlations were calculated. Results: ABI, baseline BF and BF response to RH did not correlate with ICD or TWD. VO2 at first ventilatory threshold and VO2peak were significantly and positively correlated with ICD (r = 0.41 and 0.54, respectively) and TWD (r = 0.65 and 0.71, respectively). Conclusions: VO2peak and VO2 at first ventilatory threshold, but not ABI, baseline BF and BFHR were associated with walking tolerance in IC patients. These results suggest that VO2 at first ventilatory threshold may be useful to evaluate walking tolerance and improvements in IC patients.

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The effects of exercise training on muscle oxygenation of patients with intermittent claudication

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.349 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

P Chatzinikolaou ◽

N Cornelis ◽

J Claes ◽

R Buys ◽

I Fourneau ◽

...

Keyword(s):

Intermittent Claudication ◽

Near Infrared ◽

Saturation Index ◽

Ankle Brachial Index ◽

Muscle Oxygenation ◽

Lower Limbs ◽

Current Evidence ◽

Test Time ◽

Treadmill Test ◽

Walking Capacity

Abstract Funding Acknowledgements Type of funding sources: None. Background. Intermittent claudication (IC) is characterized by a cramp-like pain during walking caused by insufficient blood flow to the lower limbs during exercise. The walking impairment caused by IC can lead to a vicious cycle of physical inactivity, decreased quality of life and progression of cardiovascular risk factors. Although current evidence supports the benefits of walking training to increase walking capacity, little is known about its effect on muscle oxygenation in this population. Purpose. The aim of this study was to investigate the effects of a hybrid 12-week walking program (combined center- and home-based walking) on muscle oxygenation of IC patients. Methods. Thirty-seven patients with IC were enrolled of which 33 completed follow-up measurements (age 71 ± 9 yrs, body mass index 26 ± 4 kg/m2, ankle brachial index (ABI) 0.7 ± 0.2) after the 12-week intervention. Outcome measures were pain-free walking capacity (PFWC), maximal walking capacity (MWC) and calf muscle oxygenation, respectively evaluated using a submaximal treadmill test, a Gardner treadmill test and near-infrared spectroscopy (NIRS). Results. After the 12-week intervention, significantly higher values (reported as median and interquartiles) for PFWC (162 m [122, 217] to 272 m [150, 401]; p < 0.001) and MWC (458 m [260, 638] to 611 m [333, 840]; p < 0.001) were observed. As shown in Table 1, NIRS data measured during the submaximal walking test showed an increased availability of oxygenated hemoglobin (p = 0.048) and decreased deoxyhemoglobin (p = 0.013), while total hemoglobin remained unchanged after the 12-week intervention. During the Gardner test, time to reach minimum tissue saturation index (TSI%) increased (p < 0.001), yet no change was noted on minimum TSI during exercise, despite increased MWC. Despite a trend towards faster recovery times, no significant changes were observed after the 12-week intervention. Conclusion. Hybrid walking exercise therapy improves deoxygenation kinetics and walking capacity in IC patients. Increased availability of oxygenated hemoglobin might underly the improvement in walking capacity.

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Micro-Lightguide Spectrophotometry (O2C) for Lower Limb Perfusion: Effects of Exercise Walking in Claudicants

International Journal of Angiology ◽

10.1055/s-0039-1692661 ◽

2019 ◽

Vol 28 (03) ◽

pp. 161-166

Author(s):

Thomas Gyldenløve ◽

Lise P. Jørgensen ◽

Torben V. Schroeder

Keyword(s):

Oxygen Saturation ◽

Intermittent Claudication ◽

Ankle Brachial Index ◽

Exercise Program ◽

Arterial Disease ◽

Treadmill Test ◽

Home Based ◽

Walking Capacity ◽

Treadmill Testing ◽

Peripheral Arterial

Background Exercise walking has improved walking capacity in patients with intermittent claudication without affecting the macrocirculation reflected in ankle pressures. We wanted to investigate microcirculation in the skin related to exercise walking by using Micro-Lightguide Spectrophotometry (O2C). Materials and Methods Twenty-eight patients with intermittent claudication—bilateral in 17—were included in a 12 weeks of structured home-based exercise program. The pain-free and maximal walking distances were determined on a treadmill. Saturation and flow, monitored by O2C, were examined immediately before and after the treadmill test. O2C examination took place before as well as after completion of the exercise program. Ankle–brachial index was obtained before treadmill testing. Results As expected, walking performance improved significantly without affecting ankle pressures. Neither oxygen saturation nor flow, assessed at 2 mm depth, was affected following a 12 weeks of exercise program. We observed a significant decrease in oxygen saturation and flow upon treadmill testing in the both limbs in patients with bilateral peripheral arterial disease (PAD). In contrast, the treadmill test elicited no changes in the opposite and asymptomatic limb in patients with only unilateral PAD. Conclusion The findings suggest that O2C may be used to study microcirculatory changes. However, it is best suited for the study of phenomena resulting in major changes as it eliminates some inherent variability.

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Indikationen und Limitationen des Gehtrainings bei Patienten mit Cladicatio intermittens

VASA ◽

10.1024/0301-1526.31.1.23 ◽

2002 ◽

Vol 31 (1) ◽

pp. 23-27 ◽

Cited By ~ 1

Author(s):

Takashi Ohta ◽

Sugimoto ◽

Takeuchi ◽

Hosaka ◽

Ishibashi

Keyword(s):

Exercise Training ◽

Intermittent Claudication ◽

Recovery Time ◽

Ankle Brachial Index ◽

Walking Distance ◽

Hemodynamic Parameters ◽

Arterial Reconstruction ◽

Arteriosclerosis Obliterans ◽

Degree Of Satisfaction ◽

Selection Of

Background: The selection of candidates for exercise training among patients with intermittent claudication is still a matter of debate. Patients and methods: Forty-nine patients with intermittent claudication due to arteriosclerosis obliterans were tested. Forty-six patients were men and 3 were women, with an average age of 65 years (range, 46 to 76 years). The patients walked on a treadmill at 2.4 km/h on a 12% upgrade followed by an appropriate period of rest for 30 minutes twice a day during a 3-week hospitalization. Programs were individualized for each patient. Four parameters were assessed after exercise training: (1) Ankle-brachial index (ABI) at rest, (2) Fall in ABI after 40 m of treadmill walking (ABI Fall 40), (3) the recovery time (RT 40) required for the ABI to return to resting levels after 40 m of walking, and (4) the maximal walking distance (MWD) on the treadmill. Results: The average ABI at rest before the 3-week training period was 0.60 ± 0.02 (mean ± SE), and after training it was 0.62 ± 0.02. There was a small although not statistically significant increase in the ABI after training. This increase in the ABI did not exceed 0.21. The average ABI Fall 40 before training was 0.36 ± 0.01, and after training it was 0.30 ± 0.02. The average RT 40 before training was 9.9 ± 0.8 min, and after training it was 6.2 ± 0.6 min. There were significant decreases in the ABI Fall 40 and RT 40 after training (p < 0.01 and p < 0.001, respectively). The MWD increased after training in 48 of the 49 patients. The average MWD increased from 134 ± 13 m to 226 ± 32 m after training (p < 0.001). The occlusion levels did not influence the results as training effects and hemodynamic parameters. Fourteen of 49 patients desired arterial reconstruction after exercise training. Conclusions: Patients with shorter RT 40’s before training achieved greater increases in the MWD after training. In patients with an RT 40 under 12 min, exercise training is indicated. However, there is some discrepancy between the increase in MWD and the degree of satisfaction in individual patients.

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Predictive value of the ankle-brachial index in the evaluation of intermittent claudication

Revista do Hospital das Clínicas ◽

10.1590/s0041-87812000000200005 ◽

2000 ◽

Vol 55 (2) ◽

pp. 61-64 ◽

Cited By ~ 18

Author(s):

Nelson Wolosker ◽

Ruben A Rosoky ◽

Lívio Nakano ◽

Márcio Basyches ◽

Pedro Puech-Leão

Keyword(s):

Intermittent Claudication ◽

Predictive Value ◽

Poor Prognosis ◽

Predictive Power ◽

Ankle Brachial Index ◽

Favorable Outcome ◽

Rehabilitation Therapy ◽

Exercise Rehabilitation ◽

Margin Of Error

The purpose of this study was to determine whether the ankle-brachial index (ABI) could be used to predict the prognosis for a patient with intermittent claudication (IC). We studied 611 patients prospectively during 28 months of follow-up. We analyzed the predictive power of using various levels of ABI - 0.30 to 0.70 at 0.05 increments - in terms of the measure's specificity (association with a favorable outcome after exercise rehabilitation therapy) and sensitivity (association with a poor outcome after exercise rehabilitation therapy). We found that using an ABI of 0.30 as a cut-off value produced the lowest margin of error overall, but the predictive power was still low with respect to identifying the patients with a poor prognosis after non-aggressive therapeutic treatment. Further study is needed to perhaps identify a second factor that could increase the sensitivity of the test.

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Frequency of Peripheral Arterial Disease Diagnosed by Measurement of the Ankle Brachial Index Among Diabetics with No Symptoms of Intermittent Claudication

Journal of the ASEAN Federation of Endocrine Societies ◽

10.15605/jafes.027.02.13 ◽

2012 ◽

Vol 27 (2) ◽

pp. 209-212

Author(s):

Sheryll Pleo ◽

◽

Jay Vincent Cresencio ◽

Elaine Alajar

Keyword(s):

Peripheral Arterial Disease ◽

Intermittent Claudication ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Peripheral Arterial

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Intermittent Claudication – Functional Status Assessment in Patient Follow-up after Successful Percutaneous Revascularization

Cardiologia Croatica ◽

10.15836/ccar2020.247 ◽

2020 ◽

Vol 15 (9-10) ◽

pp. 247-254

Author(s):

Dora Jelinek ◽

Ljiljana Banfić ◽

Majda Vrkić Kirhmajer ◽

Stipe Pelajić ◽

Savko Dobrota ◽

...

Keyword(s):

Functional Status ◽

Intermittent Claudication ◽

Status Assessment ◽

Percutaneous Revascularization

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Diet is associated with ankle-brachial index, inflammation, and ambulation in patients with intermittent claudication

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.12.038 ◽

2020 ◽

Vol 72 (4) ◽

pp. 1375-1384

Author(s):

Andrew W. Gardner ◽

Polly S. Montgomery ◽

Ming Wang ◽

Biyi Shen ◽

Ana I. Casanegra ◽

...

Keyword(s):

Intermittent Claudication ◽

Ankle Brachial Index

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Intermittent claudication - the meaning of pharmacological and non-pharmacological therapy in chronic treatment

Medycyna Faktów ◽

10.24292/01.mf.0321.4 ◽

2021 ◽

Vol 14 (3) ◽

pp. 240-243

Author(s):

Marta Wolska ◽

Pamela Czajka ◽

Marek Postuła

Keyword(s):

Intermittent Claudication ◽

Conservative Therapy ◽

Ankle Brachial Index ◽

Cardiovascular Complications ◽

Pharmacological Therapy ◽

Arterial Blood Flow ◽

Diagnostic Process ◽

Arterial Blood ◽

Artery Disease

Intermittent claudication is a typical sign of peripheral vascular disease, which results from limited arterial blood flow due to atherosclerosis, appears during exercises and is relieved after a short break. Intermittent claudication often presents as a pain in the calf muscle after walking a particular distance. Physical examination, detailed interview and ankle–brachial index are key elements of the diagnostic process, which allows for diagnosis of peripheral artery disease. The treatment is dependent on multiple factors, including the dynamics of the disease and coexisting diseases. The aim of the treatment of patients with intermittent claudication is reducing the risk of cardiovascular complications and improving the quality of life. The treatment is based on a conservative therapy, especially march training. The pharmacological treatment is limited to a few medications, which are rarely used. In the advanced stage of the disease the most appropriate option seems surgery.

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Abstract P233: History of Myocardial Infarction and Functional Status: The Reasons for Geographic and Racial Differences in Stroke Study

Circulation ◽

10.1161/circ.141.suppl_1.p233 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Emily B Levitan ◽

Joanna B Ringel ◽

Parag Goyal ◽

Orysya Soroka ◽

Madeline R Sterling ◽

...

Keyword(s):

Myocardial Infarction ◽

Functional Status ◽

Racial Differences ◽

Cardiovascular Health ◽

Short Form ◽

Health Priorities ◽

Mental Function ◽

Patient Centered ◽

A Value ◽

History Of

Background: In addition to traditional measures of cardiovascular health, individuals value the ability to conduct activities of daily living (ADLs) and physical and mental function. Whether myocardial infarction (MI) contributes to declines in these patient-centered health priorities is not known. Objective: To evaluate the association of history of MI with impairments in ADLs and physical and mental function. Methods: We included participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study without history of stroke who completed a study visit and interview in 2013-2016. Participants reported whether they had no difficulty (assigned a valued of 0), some difficulty (assigned a value of 1), or would require help (assigned a value of 2) conducting 12 basic and instrumental ADLs. We summed values across the 12 ADLs to create a score. Higher ADL impairment scores indicate more impairment. We calculated Physical and Mental Component Summary (PCS and MCS) scores from the 12-Item Short Form Health Survey. Higher PCS and MCS scores represent better function. History of MI included clinician-adjudicated MI, self-reported MI, or evidence of MI on electrocardiogram. We used logistic regression to compare prevalence of at least one ADL impairment and linear regression to compare ADL, PCS, and MCS scores between participants with and without history of MI. Results: Among 12,221 participants, 16% (n = 1,960) had a history of MI. The average age at the time of the interview was 72 (SD 8) years, 56% of the population was female, and 36% was black. Compared to participants without a history of MI, participants with a history of MI were more likely to have at least one ADL impairment and had higher average ADL impairment scores and lower average PCS and MCS scores ( Table ). Conclusion: History of MI was associated with more impairments in ADLs and worse physical and mental function in this study population. These findings suggest that prevention of MI may help prevent or delay declines functional status.

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