Rehabilitative treatment in peripheral artery disease: protocol application and follow-up.
OBJECTIVE
Peripheral arterial disease (PAD) is a chronic figure suitable to be treated at the II stage to prevent the extreme developments both of the critical limb ischemia and the amputation, as well. The aim of this study was to establish a rehabilitation program (pharmacological and physical) focused not only on the improvement of the flow but also on the metabolic rebalancing in the claudicant limb.


METHODS
The study enrolled 222 patients, (125 non-diabetics and 97 diabetics): 54 II A and 168 II B stage; 172 patients (131 II B and 41 II A; 104 non-diabetics and 68 diabetics) were submitted to iv. L-propionil carnytine (Lpc) and physical training on treadmill or exercise bike and 50 patients to iv. therapy alone. Instrumental (Rheoscreen, Oximetry, ABI, walking distance measurement) and clinical checks (questionnaire - Appendix 1) were performed at days: T0, T45,T 90,T180, T230 and during the follow up stated at T 90,T180,T360 from T 230 (end of DH).


RESULTS
A significant increasing of the walking distance has been reached in the group undergoing the rehabilitation program. Treadmill: non-diabetics +261.48% at 0% and +122.53% at slope 10% (T230) further increasing to +502.31% at 0% and +289.42% at slope 10% (T360); diabetics: + 158.49% at T0 and + 98.26% at slope 10% (T230) further increased to +287.74% at 0% and +197.39% at 10% (T360) in comparison with the group which had only iv. Lpc : non-diabetics +141.63% at 0% and +104.08% at slope 10% (T230) further increased to +202.064% at 0% and +155.10% at slope 10% (T360); diabetics: +109.124% at T0 and +100% at slop 10% (T230) further increased to +171.08% at 0% and +140% at 10% (T360) . Exercise bike: non-diabetics: +170.27% at T230 in comparison T0 increased to +305.4% at T360; diabetics: +166.66 at T230 reaching +288.88% at T 360.


CONCLUSIONS
Our rehabilitative program gives not only good results at the end of the treatment but mainly stable, with the chance to reach further improving of both walking distance and quality of life, particularly in those patients which observe constantly the physical training.
Riccioni
C
C
Department of Angiology, Local Health Unit, Rome, Italy. camriccioni@tiscali.it
Sarcinella
R
R
Izzo
A
A
Palermo
G
G
Liguori
M
M
Caliumi
C
C
Carloni
E
E
Paolucci
A M
AM
D'andrea
P
P
Pompili
S
S
D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002331:Carnitine / Q000031:analogs & derivatives / Q000627:therapeutic use; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005081:Exercise Therapy; D005121:Extremities / Q000098:blood supply; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000188:drug therapy / Q000534:rehabilitation* / Q000628:therapy; D012039:Regional Blood Flow / Q000502:physiology; D016138:Walking / Q000502:physiology
D002316:Cardiotonic Agents; C003223:propionylcarnitine; D002331:Carnitine