Vascular surgical society of great britain and ireland: angioplasty reverses the systemic effects of exercise in intermittent claudication
BACKGROUND: The choice between exercise training and percutaneous transluminal angioplasty (PTA) in the treatment of intermittent claudication (IC) remains controversial. Exercise is known to induce systemic effects in claudicants. This study aimed to determine whether such systemic effects are reversed by PTA. METHODS: Ten patients with IC were recruited before PTA. Having emptied the bladder and rested for 1 h, pre-exercise blood and urine samples were collected. Patients underwent treadmill exercise to their maximum walking time and further blood samples were collected at 10, 20 and 30 min. A second urine sample was collected at 60 min. Total antioxidant capacity (TAC) and von Willebrand factor (vWF) were measured in blood, and albumin : creatinine ratio (ACR) and retinol binding protein : creatinine ratio (RBP : Cr) in urine. Patients were recalled 2 weeks after successful angioplasty and the protocol was repeated. Statistical analysis was by Wilcoxon signed rank test. RESULTS: Following PTA, all patients walked for 5 min on the treadmill. All patients had a significant exercise-induced fall in ankle pressure that was reversed by PTA. Changes in TAC are shown in the Table. There was no significant change in vWF. Exercise in claudicants induced a significant increase in median ACR (pre/post exercise (pre-exercise value divided by post-exercise value) 0.8; P = 0.03) and in median RBP : Cr (pre/post exercise 1.8; P = 0.04). These changes were no longer evident after successful PTA. CONCLUSION: Exercise-induced changes in renal glomerular (ACR) and tubular function (RBP : Cr) in claudicants were reversed by successful angioplasty. PTA reduced the systemic TAC before and after exercise suggesting a reduced free radical challenge.
Lewis
DR
Bristol Royal Infirmary, Bristol, UK.
Day
A
Baird
RN
Smith
FC
Lamont
PM