Predictors of change in walking distance in patients with peripheral arterial disease undergoing endovascular intervention
A Afaq, J H Patel, A W Gardner, T A Hennebry, A Afaq, J H Patel, A W Gardner, T A Hennebry
Abstract
Background: Endovascular treatment of peripheral artery disease is becoming frequent, yet the clinical factors which predict ambulatory outcomes are not known.
Hypothesis: To identify predictors of change in walking distance in patients who underwent endovascular intervention for their lower extremity peripheral arterial disease (PAD).
Methods: A total of 134 patients underwent lower extremity peripheral arterial intervention, 52 patients were contacted via phone between 1 and 36 months (a mean of 22 mo) after their initial procedure. The remaining 82 patients were excluded due to the following reasons: death (n = 13), contact information was not available (n = 50), and refusal to participate in the follow-up (n = 19).
Results: The patients were 63 +/- 12 years old (mean +/- standard deviation [SD]), 46% were male, 47% were diabetics, 49% had coronary artery disease, of whom 29% had prior revascularization, and 22% had coronary artery bypass grafts (CABG). The disease severity described by Fontaine classification were as follows: 44.2% were in stage II, 15.4% were in stage III, and 40.4% were in stage IV. Walking distance was improved in 21% of patients, worsened in 73% of patients, and unchanged in 6% of patients. Stepwise multiple regression demonstrated that patients who started to walk or exercise (R = 0.372, P < 0.012) and who had a prior history of CABG (R = 0.467, P < 0.006) were the only independent predictors of the change in walking distance at follow-up. Those who started to walk reported worse walking distance at follow-up, while those with a history of CABG reported better walking distance at follow-up.
Conclusion: CABG prior to endovascular intervention is predictive of favorable change in walking distance in patients with PAD at follow-up. Therefore, post-CABG patients are good candidates for exercise rehabilitation and risk factor modification.
Copyright 2009 Wiley Periodicals, Inc.
Source: PubMed