Comparative effectiveness study of self-directed walking exercise, lower extremity revascularization, and functional decline in peripheral artery disease.
OBJECTIVE
Among individuals with peripheral artery disease (PAD), we compared annual change in 6-minute walk performance between participants who neither underwent lower extremity revascularization nor walked for exercise (group 1, reference), those who walked regularly for exercise (group 2), and those who underwent lower extremity revascularization (group 3).


METHODS
Participants were recruited from Chicago-area vascular laboratories and followed annually. Change in 6-minute walk was calculated beginning at the study visit preceding lower extremity revascularization or exercise behavior and continuing for 1 additional year after the therapy was reported. Results are adjusted for age, sex, race, comorbidities, and other confounders.


RESULTS
Of 348 PAD participants, 43 underwent revascularization during median follow-up of 84 months. Adjusted annual declines in 6-minute walk were -96.6 feet/year for group 1, -49.9 feet/year for group 2, and -32.6 feet/year for group 3 (P < .001). Forty-one percent of revascularizations were not associated with ankle-brachial index (ABI) improvement. When group 3 was limited to participants with ABI improvement ≥0.15 after revascularization, annual adjusted changes in 6-minute walk were -97.7 feet/year for group 1, -46.5 feet/year for group 2, and +68.1 feet/year for group 3 (P < .001). When group 3 was limited to participants without ABI improvement ≥0.15 after revascularization, annual adjusted changes in 6-minute walk were -99.2 feet/year for group 1, -48.0 feet/year for group 2, and -61.7 feet/year for group 3 (P < .001).


CONCLUSIONS
A large proportion of PAD participants did not have ABI improvement of at least 0.15 at follow-up study visit after revascularization. The benefits of lower extremity revascularization in patients with PAD appear closely tied to improvements in the ABI after revascularization.
Northwestern University Feinberg School of Medicine, Chicago, IL, USA. mdm608@northwestern.edu
Mary M
MM
McDermott
Melina
M
Kibbe
Jack M
JM
Guralnik
William H
WH
Pearce
Lu
L
Tian
Yihua
Y
Liao
Lihui
L
Zhao
Michael H
MH
Criqui
D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D016009:Chi-Square Distribution; D002641:Chicago; D015897:Comorbidity; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D020127:Recovery of Function; D012307:Risk Factors; D012648:Self Care; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D016138:Walking