scholarly journals Lower-limb hot-water immersion acutely induces beneficial hemodynamic and cardiovascular responses in peripheral arterial disease and healthy, elderly controls

2017 ◽  
Vol 312 (3) ◽  
pp. R281-R291 ◽  
Author(s):  
Kate N. Thomas ◽  
André M. van Rij ◽  
Samuel J. E. Lucas ◽  
James D. Cotter
Keyword(s):  
Blood Pressure ◽  
Lower Limb ◽  
Water Immersion ◽  
Duplex Ultrasound ◽  
Arterial Disease ◽  
Hot Water ◽  
Healthy Elderly ◽  
Limb Perfusion ◽  
Peripheral Arterial ◽  
Hot Water Immersion

Passive heat induces beneficial perfusion profiles, provides substantive cardiovascular strain, and reduces blood pressure, thereby holding potential for healthy and cardiovascular disease populations. The aim of this study was to assess acute responses to passive heat via lower-limb, hot-water immersion in patients with peripheral arterial disease (PAD) and healthy, elderly controls. Eleven patients with PAD (age 71 ± 6 yr, 7 male, 4 female) and 10 controls (age 72 ± 7 yr, 8 male, 2 female) underwent hot-water immersion (30-min waist-level immersion in 42.1 ± 0.6°C water). Before, during, and following immersion, brachial and popliteal artery diameter, blood flow, and shear stress were assessed using duplex ultrasound. Lower-limb perfusion was measured also using venous occlusion plethysmography and near-infrared spectroscopy. During immersion, shear rate increased ( P < 0.0001) comparably between groups in the popliteal artery (controls: +183 ± 26%; PAD: +258 ± 54%) and brachial artery (controls: +117 ± 24%; PAD: +107 ± 32%). Lower-limb blood flow increased significantly in both groups, as measured from duplex ultrasound (>200%), plethysmography (>100%), and spectroscopy, while central and peripheral pulse-wave velocity decreased in both groups. Mean arterial blood pressure was reduced by 22 ± 9 mmHg (main effect P < 0.0001, interaction P = 0.60) during immersion, and remained 7 ± 7 mmHg lower 3 h afterward. In PAD, popliteal shear profiles and claudication both compared favorably with those measured immediately following symptom-limited walking. A 30-min hot-water immersion is a practical means of delivering heat therapy to PAD patients and healthy, elderly individuals to induce appreciable systemic (chronotropic and blood pressure lowering) and hemodynamic (upper and lower-limb perfusion and shear rate increases) responses.

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

2019 ◽  
Vol 316 (6) ◽  
pp. H1495-H1506 ◽  
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/ .

scholarly journals Substantive hemodynamic and thermal strain upon completing lower-limb hot-water immersion; comparisons with treadmill running

Temperature ◽  
2016 ◽  
Vol 3 (2) ◽  
pp. 286-297 ◽  
Author(s):  
Kate N. Thomas ◽  
André M. van Rij ◽  
Samuel J.E. Lucas ◽  
Andrew R. Gray ◽  
James D. Cotter
Keyword(s):  
Lower Limb ◽  
Water Immersion ◽  
Thermal Strain ◽  
Hot Water ◽  
Treadmill Running ◽  
Hot Water Immersion

Toe brachial index measured by automated device compared to duplex ultrasonography for detecting peripheral arterial disease in older people

Vascular ◽  
2017 ◽  
Vol 25 (6) ◽  
pp. 612-617 ◽  
Author(s):  
Jennifer Sonter ◽  
Peta Tehan ◽  
Vivienne Chuter
Keyword(s):  
Blood Pressure ◽  
Peripheral Arterial Disease ◽  
Older People ◽  
Diagnostic Accuracy ◽  
Lower Limb ◽  
Arterial Disease ◽  
Duplex Ultrasonography ◽  
Toe Brachial Index ◽  
Peripheral Arterial ◽  
Toe Blood Pressure

Introduction To investigate the diagnostic accuracy of an automated toe blood pressure device for detecting peripheral arterial disease in older people. Methods Ninety participants underwent toe and brachial blood pressure measurements and colour duplex ultrasonography of the right lower limb. Peripheral arterial disease was diagnosed if > 50% arterial obstruction was identified in any lower limb vessel using colour duplex ultrasonography. A receiver operating characteristic curve was analysed and the sensitivity and specificity of commonly used toe brachial index and toe blood pressure values were determined. Results The optimum toe brachial index threshold value for diagnosing peripheral arterial disease was 0.72 (sensitivity 76.2%, specificity 75%). The area under the curve was 0.829 (95% CI 0.743 to 0.915, p < 0.0001) suggesting fair diagnostic accuracy. A toe blood pressure of 70 mmHg was found to have excellent specificity (97.92%) for detecting PAD but poor sensitivity (42.86%). Conclusions The accuracy of automated toe blood pressure and TBI measurements was determined to be good when using colour duplex ultrasound as the reference standard for the non-invasive diagnosis of peripheral arterial disease. Results should be interpreted in the context of all clinical signs and symptoms.

Role of Doppler Ultrasound in Comparison With MDCT Angiography in the Assessment of Lower Limb PAD

2021 ◽  
Vol 15 (11) ◽  
pp. 2936-2937
Author(s):  
Mehwish Tahir ◽  
Sadaf Iqbal ◽  
Maimoona Gulshan
Keyword(s):  
Doppler Ultrasound ◽  
Lower Limb ◽  
Multidetector Ct ◽  
Duplex Ultrasound ◽  
Arterial Disease ◽  
Radiology Department ◽  
Atherosclerotic Plaques ◽  
Mdct Angiography ◽  
Peripheral Arterial

Aim: Role of Doppler ultrasound in comparison with MDCT angiography in the assessment of lower limb Peripheral arterial disease. Methodology: This study was conducted in Radiology department of Shalamar Hospital Lahore. A total of 42 patients (31 males and 11 females) diagnosed with PAD by using both Doppler ultrasound and MDCTA were included. The data collected was entered, tabulated and statistically analyzed on IBM-SPSS 25.0 version. Results: A total of 336 arterial segments were assessed on both modalities. Duplex ultrasound detected 278 (83%) positive patent segments, 124(37%) segments showing atherosclerosis and 63(19%) segments with stenosis/thrombus, in comparison to MDCTA which was able to detect 221 (66%) patent vessels,153(46%) segments showing atherosclerosis and 114 (34%) segments showing thrombus/ stenosis. The results showed that the MDCTA was able to detect 15% more arterial segments with stenosis/ thrombus and 9% more segments with atherosclerotic plaques as compared to Doppler. Conclusion: Doppler ultrasound is the modality of choice in detecting grade 0 and 1 PAD while. MDCTA is more accurate in assessing patients with grade 2 and 3 PAD who need surgical intervention. Key Words: PAD, Duplex ultrasound, Multidetector CT Angiography

scholarly journals Transpedal Approach in Failed Antegrade Attempt of Lower Limb Peripheral Arterial Disease—A Review with Different Treatment Strategies

2020 ◽  
Vol 29 (03) ◽  
pp. 143-148
Author(s):  
Ranjit Kumar Nath ◽  
Siva Subramaniyan ◽  
Neeraj Pandit ◽  
Deepankar Vatsa
Keyword(s):  
High Risk ◽  
Peripheral Arterial Disease ◽  
Femoral Artery ◽  
Lower Limb ◽  
Treatment Strategies ◽  
Arterial Disease ◽  
Retrograde Approach ◽  
Femoral Access ◽  
Antegrade Approach ◽  
Peripheral Arterial

AbstractTranspedal access is an evolving technique primarily used in patients after failed femoral antegrade approach to revascularize complex tibiopedal lesions. In patients who are at high risk for surgery the transpedal access may be the only option in failed antegrade femoral access to avoid amputation of the limbs. In recent years transpedal access is used routinely to revascularize supra-popliteal lesions due to more success and less complications over femoral artery approach. Retrograde approach parse will not give success in all cases and importantly success depends on techniques used. There are different techniques that need to be used depending on lesion characteristics, comorbidities, and hardware available to improve success with less complications. This review provides different strategies for successful treatment of iliac and femoral artery lesions by transpedal approach after failed antegrade femoral attempt.

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