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February 21, 2017

Improving Lower Extremity Functioning in Peripheral Artery Disease: Exercise, Endovascular Revascularization, or Both?

Author Affiliations
  • 1Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Senior Editor, JAMA
  • 3Department of Surgery, University of North Carolina at Chapel Hill
  • 4Editor, JAMA Surgery

Copyright 2017 American Medical Association. All Rights Reserved.

JAMA. 2017;317(7):689-690. doi:10.1001/jama.2016.20673

Lower extremity peripheral artery disease (PAD) now affects approximately 8.5 million adults 40 years and older in the United States and approximately 202 million adults worldwide.1 PAD is atherosclerotic disease of the arteries supplying the legs, resulting in impaired oxygen delivery to leg muscles during walking activities. Most people with PAD will never experience critical limb ischemia, which includes pain at rest, nonhealing leg ulcers, or gangrene. However, even without critical limb ischemia, patients with PAD have significant functional impairment that is manifest as poor walking endurance, poor physical activity, and faster functional decline than people without PAD. Among 666 participants (412 with PAD) in the Walking and Leg Circulation Study, participants with severe PAD were 4.2 times more likely and those with mild PAD were 3.2 times more likely to become unable to walk one-quarter of a mile or walk up 1 flight of stairs without assistance compared with people without PAD at 5-year follow-up, independently of age, comorbidities, and other confounders.2