Objectives: This study determined whether revascularization improves
quality of life and limb function in patients with peripheral artery disease
(PAD).
Methods: Thirty-five patients with bilateral claudication (Fontaine stage
II) were evaluated with quality of life questionnaires, maximal walk tests,
a maximal isometric plantar flexion test, and overground gait analysis
before and 6 months after revascularization. Ground reaction forces
and joint angles, torques, and powers for the ankle, knee, and hip were
analyzed in each phase of stance (weight acceptance, single-leg support,
and propulsion) in pain-free and pain-induced conditions. Paired t-tests
evaluated measures of quality of life, walking distances, and plantar flexor
strength. A two-factor (intervention; condition) repeated-measures analysis
of variance evaluated gait variables for the more symptomatic leg
(P < .05).
Results: All measures of quality of life, walking distances, and plantar
flexor strength improved after revascularization. Gait also improved;
during weight acceptance, ankle dorsiflexion angle decreased, while
peak vertical impact and braking force, braking impulse, and power
at the ankle and knee increased in magnitude after revascularization.
During single-leg support, knee power increased after revascularization.
During propulsion, peak vertical push-off and propulsive force, ankle
plantar flexor torque and power, and knee power increased in magnitude
after revascularization. Each significant gait variable, except knee
power during propulsion, became more similar to values of healthy
controls. Effects of condition occurred at the ankle, knee, and hip
throughout stance with gait worsening in the pain-induced condition
(Table).
Conclusions: Six months after revascularization, bilateral claudicating
patients with PAD demonstrate significant improvements in quality of
life, walking distances, plantar flexor strength, and gait biomechanics at
the level of the ankle and knee. Limb function does not return to normal,
as evidenced by a lack of improvement at the hip during pain-free gait
and worsened gait at the ankle, knee, and hip after the onset of claudication
pain. Persistence of malfunction may be the product of residual
occlusive disease despite revascularization and persistent neuromyopathy
of the affected legs.
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