Restoring leg blood flow is better option than exercise for PAD patients

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Courtesy University of Nebraska Medical Center

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A graduate student from the University of Nebraska Medical Center was the lead author of a study which found that restoring blood flow to the legs of patients with peripheral artery disease (PAD) may stop the progression of scarring in their leg muscles.

PAD causes pain and fatigue while walking due to poor blood circulation in arteries that supply blood to the limbs. The decreased blood flow can lead to substantial scarring and damage in leg muscles.

There are currently no available treatments once the scarring has occurred. Supervised exercise therapy and revascularization procedures (which reopen or bypass blockages in the blood vessels) may help PAD patients walk further and longer, but it is not known if these treatments affect the scarring process.

Duy Ha, a doctoral candidate in cellular and integrative physiology, was the lead author on the study. Ha, who is pursuing a combined M.D., Ph.D. degree, was one of only six researchers who were selected to give a moderated poster presentation in which he gave an oral presentation on the poster in front of a crowd of researchers.

Six months later, they compared changes in biopsy results among 30 patients who underwent revascularization, 25 who participated in a supervised exercise program, and 17 who had no treatment.

Among the findings:

--scarring factors -- collagen fibers and TGF-beta1 -- increased in the exercise and control groups, but not in the revascularization group;

--patients in both the revascularization and exercise groups increased their maximum walking time on treadmill, before calf pain made it impossible to continue;

--only patients in the revascularization group improved the distance they could walk in six minutes.

Neither exercise nor revascularization treatment reversed scarring that had already taken place in the calf muscles.

"Increasing blood flow to the leg with revascularization procedures halted the progression of scarring and allowed the patients to walk longer and further," Ha said. This suggests that the long-term benefits to the health of leg muscles are better with revascularization than with exercise therapy alone. Unfortunately, not all patients are candidates for these procedures, which carry significant risks, and the treated vessels may get blocked again.

(A Wellness Update is a magazine devoted to up-to-the minute information on health issues from physicians, major hospitals and clinics, universities and health care agencies across the U.S. Online at www.awellnessupdate.com.)

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