Percutaneous intervention in peripheral artery disease improves calf muscle phosphocreatine recovery kinetics: A pilot study

• Published in: Vascular medicine (London, England) England), 2012-02, Vol.17 (1), p.3-9
• Main Authors: West, Amy M, Anderson, Justin D, Epstein, Frederick H, Meyer, Craig H, Hagspiel, Klaus D, Berr, Stuart S, Harthun, Nancy L, Weltman, Arthur L, Annex, Brian H, Kramer, Christopher M
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Ankle Brachial Index; Biological and medical sciences; Blood and lymphatic vessels; Blood vessels and receptors; Cardiology. Vascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Exercise - physiology; Exercise Test; Female; Fundamental and applied biological sciences. Psychology; Humans; Intermittent Claudication - surgery; Leg - blood supply; Magnetic Resonance Angiography; Magnetic Resonance Spectroscopy; Male; Medical sciences; Middle Aged; Muscle, Skeletal - blood supply; Muscle, Skeletal - metabolism; Peripheral Arterial Disease - diagnosis; Peripheral Arterial Disease - metabolism; Peripheral Arterial Disease - surgery; Phosphocreatine - metabolism; Pilot Projects; Regional Blood Flow; Vascular Surgical Procedures - methods; Vertebrates: cardiovascular system
• ISSN: 1358-863X; 1477-0377
• DOI: 10.1177/1358863X11431837

We hypothesized that percutaneous intervention in the affected lower extremity artery would improve calf muscle perfusion and cellular metabolism in patients with claudication and peripheral artery disease (PAD) as measured by magnetic resonance imaging (MRI) and spectroscopy (MRS). Ten patients with symptomatic PAD (mean ± SD: age 57 ± 9 years; ankle–brachial index (ABI) 0.62 ± 0.17; seven males) were studied 2 months before and 10 months after lower extremity percutaneous intervention. Calf muscle phosphocreatine recovery time constant (PCr) in the revascularized leg was measured by 31P MRS immediately after symptom-limited exercise on a 1.5-T scanner. Calf muscle perfusion was measured using first-pass gadolinium-enhanced MRI at peak exercise. A 6-minute walk and treadmill test were performed. The PCr recovery time constant improved significantly following intervention (91 ± 33 s to 52 ± 34 s, p < 0.003). Rest ABI also improved (0.62 ± 0.17 to 0.93 ± 0.25, p < 0.003). There was no difference in MRI-measured tissue perfusion or exercise parameters, although the study was underpowered for these endpoints. In conclusion, in this pilot study, successful large vessel percutaneous intervention in patients with symptomatic claudication, results in improved ABI and calf muscle phosphocreatine recovery kinetics.