Successful lower extremity angioplasty improves brachial artery flow-mediated dilation in patients with peripheral arterial disease.
BACKGROUND
Peripheral arterial disease (PAD) is associated with systemic impaired flow-mediated dilation (FMD) and increased risk for cardiovascular events. Decreased FMD may be caused by a decrease in arterial shear stress due to claudication and inflammation due to muscle ischemia and reperfusion. We assumed that endovascular revascularization of lower limb arterial obstructions ameliorates FMD and lowers inflammation through improvement of peripheral perfusion.


METHODS
The study was a prospective, open, randomized, controlled, single-center follow-up evaluation assessing the effect of endovascular revascularization on brachial artery reactivity (FMD) measured by ultrasound, white blood cell (WBC) count, high-sensitive C-reactive protein (hs-CRP), and fibrinogen. We investigated 33 patients (23 men) with chronic and stable PAD (Rutherford 2 to 3) due to femoropopliteal obstruction. Variables were assessed at baseline and after 4 weeks in 17 patients (group A) who underwent endovascular revascularization and best medical treatment, and in 16 patients (group B) who received best medical treatment only.


RESULTS
FMD did not differ between group A and B (4.96% +/- 1.86% vs 4.60% +/- 2.95%; P = .87) at baseline. It significantly improved after revascularization in group A (6.44% +/- 2.88%; P = .02) compared with group B at 4 weeks of follow-up (4.53% +/- 3.17%; P = .92), where it remained unchanged. The baseline ankle-brachial index (ABI) was similar for group A and B (0.63 +/- 0.15 vs 0.66 +/- 0.10; P = .36). At 4 weeks of follow-up, ABI was significantly increased in group A (1.05 +/- 0.15; P = .0004) but remained unchanged in group B (0.62 +/- 0.1). WBC counts of the two groups were comparable at baseline (group A: 7.6 +/- 2.26 x 10(6)/mL and group B: 7.8 +/- 2.02 x 10(6)/mL, P = .81). In group A, the leukocyte count significantly decreased after angioplasty from 7.6 +/- 2.26 to 6.89 +/- 1.35 x 10(6)/mL (P = .03). For group B, WBC count did not differ significantly compared with baseline (7.76 +/- 2.64 x 10(6)/mL; P = .94). No effects were observed on hs-CRP or fibrinogen from endovascular therapy.


CONCLUSIONS
Endovascular revascularization with reestablishment of peripheral arterial perfusion improves FMD and reduces WBC count in patients with claudication. Revascularization may therefore have clinical implications beyond relief of symptoms, for example, reducing oxidative stress caused by repeated muscle ischemia or increased shear stress due to improved ambulatory activity.
Husmann
Marc
M
Cardiovascular Department, Division of Clinical and Interventional Angiology, University Hospital Berne and University of Berne, Berne, Switzerland. husmann@gmx.ch
Dörffler-Melly
Janine
J
Kalka
Christoph
C
Diehm
Nicolas
N
Baumgartner
Iris
I
Silvestro
Antonio
A
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D000842:Ankle / Q000098:blood supply; D001157:Arterial Occlusive Diseases / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007383:Intermittent Claudication / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D007958:Leukocyte Count; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011446:Prospective Studies; D012039:Regional Blood Flow; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014664:Vasodilation
D018836:Inflammation Mediators; D005340:Fibrinogen; D002097:C-Reactive Protein