title: Extracorporeal shock wave therapy improves the walking ability of patients with peripheral artery disease and intermittent claudication.
abstract: BACKGROUND
  Despite the recent advances in bypass surgery and catheter interventional therapy for peripheral artery disease (PAD), the long-term outcome of revascularization therapy for infrapopliteal lesions remains unsatisfactory. We have previously demonstrated that low-energy extracorporeal shock wave (SW) therapy effectively induces neovascularization through upregulation of angiogenic factors and improves myocardial ischemia in pigs and humans and in hindlimb ischemia in rabbits. In this study, we thus examined whether our SW therapy also improves the walking ability of patients with PAD and intermittent claudication.
  
  
  RESULTS
  We treated 12 patients (19 limbs) in Fontaine II stage (males/females, 10/2; 60-86 years old) with low-energy SW therapy to their ischemic calf muscle 3 times/week for 3 consecutive weeks. After 24 weeks, the pain and distance subscale scores of the walking impairment questionnaire were significantly improved (33±25 vs. 64±26, 27±16 vs. 64±23, respectively, both P<0.01). Maximum walking distance was also significantly improved at 4 weeks (151±37% from baseline, P<0.01) and was maintained at 24 weeks (180±74% from baseline, P<0.01). Moreover, the recovery time of the tissue oxygenation index in the calf muscle during a treadmill test, which reflects local O<inf>2</inf> supply, was significantly shortened (295±222s vs. 146±137s, P<0.01). Importantly, no adverse effects were noted.
  
  
  CONCLUSIONS
  Non-invasive SW therapy improves the walking ability of PAD patients.
authors.affiliation: Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Fukashi
authors.initials: F
authors.lastname: Serizawa
authors.forename: Kenta
authors.initials: K
authors.lastname: Ito
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Kawamura
authors.forename: Ken
authors.initials: K
authors.lastname: Tsuchida
authors.forename: Yo
authors.initials: Y
authors.lastname: Hamada
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Zukeran
authors.forename: Takuya
authors.initials: T
authors.lastname: Shimizu
authors.forename: Daijiro
authors.initials: D
authors.lastname: Akamatsu
authors.forename: Munetaka
authors.initials: M
authors.lastname: Hashimoto
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Goto
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Watanabe
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimokawa
authors.forename: Susumu
authors.initials: S
authors.lastname: Satomi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D005080:Exercise Test; D005260:Female; D019220:High-Energy Shock Waves / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007564:Japan; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000378:metabolism / Q000503:physiopathology; D010101:Oxygen Consumption; D010146:Pain / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D010147:Pain Measurement; D058729:Peripheral Arterial Disease / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000009:adverse effects; D016138:Walking