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This document, published in the journal Vascular Medicine, discusses the use of daily steps to identify patients with peripheral artery disease (PAD) who have high sedentary time and low physical activity. The study aimed to establish specific cut-off points for distinguishing between healthy and unhealthy combined profiles of sedentary time and moderate-to-vigorous physical activity (MVPA) among patients with PAD and claudication symptoms. The researchers found that daily steps can be used as a clinically useful metric to discriminate between patients with healthy and unhealthy combined profiles of sedentary time and MVPA. Patients with a healthy profile had better six-minute walk test performance and higher ankle-brachial index (ABI) compared to those with an unhealthy profile. The study suggests that patients who achieve at least 6,000 steps per day have the healthiest combined profile, while those who take less than 3,000 steps per day are likely to have an unhealthy profile and require closer care. Increasing daily step counts by at least 1,000 steps is recommended for patients with an unhealthy profile. The findings have important implications for healthcare professionals and can be used to set step count goals for patients with PAD. [Extracted from the article]

When matched for mechanical work, lower muscle oxygen desaturation (less exercise-induced ischemia) was observed during DSW, suggesting a better match between oxygen delivery and consumption during eccentric exercise in patients with symptomatic PAD. Keywords: claudication; exercise therapy; peripheral artery disease (PAD); physical actvity EN claudication exercise therapy peripheral artery disease (PAD) physical actvity 171 173 3 04/12/22 20220401 NES 220401 In patients with symptomatic lower extremity peripheral artery disease (PAD), supervised exercise training (SET) is among first-choice therapeutic options.[1],[2] Walking is the common training modality.[2] However, some patients have poor SET adherence,[3] suggesting the need for alternative training modalities. Indeed, since stimulating skeletal muscle ischemia or improving cardiovascular and endothelial function are the main postulated mechanisms usually linked to improved walking performance,[2] the potential benefits of DSW training on muscle and walking capacities remain to be determined in patients with PAD. [Extracted from the article]

Proximal claudication is secondary to ischemia caused by peripheral artery disease (PAD), whereas proximal pseudo-claudication is secondary to other disease processes such as hip arthritis, spinal stenosis, neuropathy, and so forth. The differentiation between the two can be challenging. Exercise transcutaneous oxygen pressure measurement (exercise-TcPO2) allows noninvasive detection of flow-reducing lesions in the proximal arteries and tributaries of the lower extremity arterial tree. We present the first case report in the United States using an exercise-TcPO2 algorithm. A 71-year-old diabetic patient with proximal left-sided and right-calf claudication with indeterminate ankle-brachial indices underwent an exercise-TcPO2 study before and after endovascular intervention. Four TcPO2 probes were placed: one at chest level (reference probe), one on each buttock, and one on the symptomatic calf. The Delta from Resting Oxygen Pressure (DROP) index was calculated at each probe site using a previously validated protocol. Proximal left- and right-calf ischemia were confirmed by the initial exercise-TcPO2, and, after endovascular treatment of the left iliac artery lesion, improvements in proximal exercise-TcPO2 values were found. These data suggest that exercise-TcPO2 can be useful in PAD evaluation in patients with non-compressible arteries and/or proximal claudication. [ABSTRACT FROM PUBLISHER]

The pathophysiology and time course of an individual converting from asymptomatic peripheral artery disease (PAD) to symptomatic claudication is unclear. The objectives of this study were: (1) to characterize the extent of atherosclerotic disease in individuals with an abnormal ankle–brachial index (ABI), but without claudication; and over 1 year of follow-up to (2) evaluate the progression of PAD using ultrasound imaging, (3) determine changes in the ABI and leg pain symptoms, and (4) correlate PAD progression with changes in the ABI and leg symptoms. We hypothesized that PAD progression would be associated with the development of claudication and changes in the ABI, 6-minute walk distance (6-MWD), and walking quality of life. Individuals with a reduced ABI but without typical intermittent claudication noted on community screening were invited to undergo baseline and 1-year follow-up assessment, including duplex ultrasound. The initial and repeat evaluations included measurement of the ABI, lower extremity duplex arterial mapping, and assessment of leg pain and functional status. Of the 50 people studied, 44 (88%) had significant atherosclerotic lesions in the lower extremity arteries, affecting 80 legs. A total of 33 of 50 individuals (66%) returned for the 1-year follow-up visit. On ultrasound examination, two of 18 normal legs developed PAD, and in 48 legs with PAD at baseline, 17 legs (35%) developed new or progressive lesions. Thirteen legs developed new claudication. Overall, there was no significant worsening in the ABI, 6-MWD, or the Walking Impairment Questionnaire (WIQ). However, legs with new lesions or lesion progression were significantly more likely to develop claudication, and the 13 legs (seven subjects) developing claudication showed a significant decline in the 6-MWD. In conclusion, these data indicate that a significant number of people with asymptomatic PAD show progression over 1 year, that such individuals are more likely to develop claudication, and that those developing claudication have a significant decrease in their 6-MWD. [ABSTRACT FROM AUTHOR]

The objective of this paper is to describe outcomes of endovascular therapy in patients with symptomatic common femoral artery (CFA) lesions. Symptomatic atherosclerotic disease of the common femoral artery is an uncommon clinical entity, and there is no consensus regarding the suitability of catheter-based therapy. We reviewed the records of 26 consecutive patients treated with catheter-based therapy for symptomatic CFA lesions between 1994 and 2009. Angiographic success and procedure success were obtained in all vessels and in all patients. At 1 year, 100% (16/16) of the claudication patients and 70% (7/10) of the critical limb ischemia (CLI) patients maintained clinical success. The ankle— brachial index (ABI) significantly improved from a baseline of 0.47 ± 0.18 to 0.77 ± 0.18 (p < 0.001) after the procedure. At their most recent clinic visit (31 months ± 14 months), clinical success was maintained in 100% of the claudication patients and in 70% (7/10) of the CLI patients. During the follow-up period, femoral vascular access for an unrelated procedure was obtained through the CFA stent. In conclusion, patients with symptomatic CFA atherosclerotic disease obtained excellent clinical outcomes with angioplasty with stenting. We found that angioplasty with stenting of the CFA did not preclude future CFA vascular access. Our data suggest that catheter-based therapies should be considered as an option to open surgery in selected patients with symptomatic CFA disease. [ABSTRACT FROM AUTHOR]