Is There a Role for the Vascular Laboratory in Supporting Home-Based Vascular Rehabilitation Programs?

Abstract

A pilot study assessing the efficacy of a nonsupervised exercise program for intermittent claudication is described, and case descriptions of 4 patients are presented. The ankle/brachial index (ABI) has long been the standard for evaluating lower limb perfusion; however, the ABI is not reliable with noncompressible arteries. Pedal acceleration time (PAT), a novel technique that quantifies perfusion using duplex ultrasound by measuring the acceleration time of the arterial waveform, has been found to be more reliable. When considering only ABI, nonsupervised exercise is not sufficient management of claudication in peripheral arterial disease (PAD), but PAT may be more sensitive to changes in collateral blood flow developed by exercise. We initiated a pre-post study from a single institution over 6 weeks that included a walking program for patients with claudication with modified resistance band exercises for amputees. Changes in symptoms, smoking, and the perfusion markers of resting ABI and anterior pedal and posterior pedal PAT were monitored. Of the 4 patients described, 3 noted symptomatic improvement with categorical improvement in PAT. Compliant patients do report success with at-home exercise regimens. Patients who are unsuccessful may benefit from supervised vascular rehabilitation. PAT, in comparison with ABI, may offer a better approach to monitor this progression and offer a stepwise approach to the management of PAD.