Arterial dysfunction and functional performance in patients with peripheral                 artery disease: A review

Coutinho, Thais; Rooke, Thom W.; Kullo, Iftikhar J.

doi:10.1177/1358863x11400935

Cited by 47 publications

(46 citation statements)

References 79 publications

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“…47,48 Through these mechanisms, impaired endothelial function as assessed by flow-mediated dilation has been correlated with the clinical severity of PAD. 49,50 Furthermore, in studies where leg blood flow was measured by using a thermodilution catheter, there was a correlation (r=0.71) between maximal leg blood flow and performance on a bicycle ergometer. 31 Interestingly, endothelial dysfunction was recently associated with walking impairment independent of the ABI, suggesting that endothelial dysfunction may contribute to the exercise impairment in PAD.…”

Section: Endothelial and Microcirculatory Dysfunctionmentioning

confidence: 99%

Pathogenesis of the Limb Manifestations and Exercise Limitations in Peripheral Artery Disease

Hiatt¹,

Armstrong²,

Larson³

et al. 2015

Circulation Research

137

118

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P eripheral artery disease (PAD) is initiated by atherogenic mechanisms common to all major vascular territories but encompasses several distinctly important clinical sequelae.1 The global burden of PAD is large and rising, with substantial morbidity and mortality found in high-, middle-, and low-income countries. 2 The atherosclerotic occlusive disease underlying PAD is associated with an exercise limitation in the majority of patients, whereas the classic symptoms of intermittent claudication, ischemic rest pain, and ischemic ulceration are less common manifestations. 3 Patients with PAD are also at increased risk of myocardial infarction, ischemic stroke, heart failure, renovascular hypertension, and vascular death reflecting the systemic atherosclerotic burden. [4][5][6] The epidemiology of Peripheral Artery Disease Compendium© 2015 American Heart Association, Inc. The diagnosis of PAD can be ascertained by simple hemodynamic measurements, in particular, the ankle-brachial index (ABI), a test performed by measuring the systolic blood pressure in each arm and the dorsalis pedis and posterior tibial arteries of each ankle. The highest of the dorsalis pedis or posterior tibial artery pressures is the numerator of the ABI specific to each leg, whereas the highest arm pressure on either side is the denominator. A ratio of <0.90 in either leg is considered hemodynamic evidence of PAD. 16 When imaged, PAD can be characterized as one or more arterial stenoses or occlusions involving the distal aorta, iliac, femoral, popliteal, or tibial arteries. 17The underlying mechanisms responsible for the functional limitations in PAD are hemodynamic in origin, which affects the supply of oxygen and substrates to metabolically active tissue: skeletal muscle in the case of intermittent claudication and skin and subcutaneous tissues in the case of critical leg ischemia. However, additional pathophysiologic mechanisms contribute to the limb manifestations, where a reduction in blood flow alone does not fully account for the exercise limitation. Recent research into the pathophysiology of this exercise limitation has identified several important sequelae resultant from the chronic hemodynamic deficit. These changes affecting the vasculature and skeletal muscle distal to the primary hemodynamic lesions likely contribute to the mechanisms of exercise limitation in PAD. These advances are reviewed here with an additional focus on identifying possible future therapeutic strategies. Symptomatic Manifestations and Exercise Limitations in PADIn the coronary circulation, plaque rupture leading to acute ischemic events is a common clinical presentation; in PAD, progressive atherosclerosis leading to chronic stenosis and occlusion, often in series, in the arteries supplying the lower extremities dominates the symptomatic manifestations.6 Limb SymptomsPatients with PAD may present with a range of limb symptoms. Most patients are either asymptomatic or have atypical limb symptoms during exercise, whereas only a third have typical symptoms of c...

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Section: Endothelial and Microcirculatory Dysfunctionmentioning

confidence: 99%

Pathogenesis of the Limb Manifestations and Exercise Limitations in Peripheral Artery Disease

Hiatt¹,

Armstrong²,

Larson³

et al. 2015

Circulation Research

137

118

View full text Add to dashboard Cite

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“…[72][73][74][75] The variability in results between these previous studies could in part be accounted for by differences in the inclusion/exclusion of patients with already diagnosed systemic vascular disease, especially because arterial stiffness is a measure of vascular function. 76 Because most patients with glaucoma seen in day-to-day practice experience several vascular pathologies, a careful selection of only patients free from such diseases could bias results toward very rare occurrences. Consequently, in the current study, we included POAG and NTG patients with well-controlled hypertension, along with a similar number of individuals with such status in the control group.…”

Section: Commentmentioning

confidence: 99%

Primary Open-Angle Glaucoma vs Normal-Tension Glaucoma

et al. 2013

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“…Plausible explanation for this association could be the lack of diastolic augmentation, coupled with the increased afterload that may contribute to decreased myocardial perfusion, leading to further supply/demand mismatch and ischemia. Moreover, ventricular-vascular uncoupling with concomitant diastolic dysfunction could amplify poor exercise tolerance, while increased stiffness may suggest microcirculatory dysfunction that leads to impaired perfusion of skeletal muscles during rest and exercise, thereby impairing the performance of skeletal muscles [ 13 ]. Finally, increased stiffness is associated with impaired fl ow volume in lower extremity arteries even in subjects with normal ABI [ 23 ].…”

Section: Pad and Arterial Stiffnessmentioning

confidence: 97%

“…Vascular dysfunction (arterial stiffness and endothelial dysfunction) is also commonly present in PAD patients [ 13 ]. In a large population-based cohort study with over 3,000 elderly subjects, patients with PAD as defi ned by ABI < 0.9 had higher values of carotid-femoral pulse wave velocity (PWV) compared to patients without PAD [ 14 ].…”

Section: Pad and Arterial Stiffnessmentioning

confidence: 99%

Arterial Stiffness and Risk in Various Cardiovascular Diseases

Vlachopoulos

Terentes‐Printzios

Takazawa

et al. 2014

Blood Pressure and Arterial Wall Mechanics in Cardiovascular Diseases

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Atherosclerotic disease comprises four major areas: coronary artery disease, cerebrovascular disease, peripheral arterial disease, and aortic aneurysm. Investigators have mainly focused on using arterial stiffness and central hemodynamics indices for primary prevention and prediction of risk in patients without cardiovascular disease. Their role in these patients is constantly evolving, and in some cases such as hypertensives and diabetics, their clinical signifi cance has been corroborated by recent guidelines and recommendations. Despite the overwhelming data for their predictive role in primary prevention, secondary prevention prognostic studies are lacking. Especially, data on the role of arterial stiffness in peripheral arterial disease patients, including patients with vasculogenic erectile dysfunction or aortic disease such as aortic aneurysm, Marfan syndrome, and coarctation of the aorta, emerge mostly from cross-sectional studies. Respectively, most prospective predictive studies of arterial stiffness have not used peripheral arterial disease or aortic disease endpoints as an exclusive outcome but preferably as a part of a composite cardiovascular endpoint. This chapter will focus on the link between arterial stiffness and risk of cardiovascular events and organ damage in other cardiovascular diseases such as peripheral arterial and aortic diseases.

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Arterial dysfunction and functional performance in patients with peripheral artery disease: A review

Cited by 47 publications

References 79 publications

Pathogenesis of the Limb Manifestations and Exercise Limitations in Peripheral Artery Disease

Pathogenesis of the Limb Manifestations and Exercise Limitations in Peripheral Artery Disease

Primary Open-Angle Glaucoma vs Normal-Tension Glaucoma

Arterial Stiffness and Risk in Various Cardiovascular Diseases

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