Improved gait parameters following surgical revascularization in patients with intermittent claudication

Abstract

Objective: Intermittent claudication (IC) is known to be associated with impaired gait parameters, with a higher incidence of falls and higher oxygen consumption due to uneconomic walking. However, the influence of arterial disobliteration in patients with IC on their gait pattern has rarely been investigated to date. The aim of this study was to examine the gait patterns before and after inflow revascularization by surgical disobliteration of pelvic and inguinal arteries (ie, common iliac artery, external iliac artery, common femoral artery, profound femoral artery, superficial femoral artery) in IC patients. Successful surgical disobliteration of inflow arteries (improvement of ankle brachial pressure index of ≥0.2 and patent common iliac, external iliac, common femoral, profound femoral, and superficial femoral arteries) is known to improve the painless walking distance for patients with IC due to peripheral arterial disease; however, its influence on gait parameters is unclear. We hypothesized that the gait parameters would also improve after surgery. Improved gait parameters can lead to a more economic walking process, lower oxygen consumption, a lower risk of falls, and a higher quality of life. Methods: In a single-center, exploratory, longitudinal study, we examined the gait parameters of 20 IC inpatients of our hospital before and after surgical disobliteration of pelvic and inguinal arteries. Spatiotemporal parameters such as range of motion of the hip and knee joint, stance phase, cadence, and foot rotation were obtained using the Diers 4Dmotion Lab (Diers International). The gait parameters were obtained under painful walking conditions preoperatively and with the patients walking pain free at the same speed postoperatively. Results: A total of 20 patients were examined. Surgical revascularization led to a higher walking cadence (mean, plus 7.88 steps; 95.5 steps/min vs 87.6 steps/min; P = .024), an increased range of motion of the hip joint (mean, plus 2.0°; 35.1° vs 33.1°; P = .038), and improved foot rotation (mean, plus 2.0°; 11.0° vs 9.0°; P = .02). Regarding other parameters such as step length, stance phase, and step duration, smaller differences were detected in this study. Conclusions: In this exploratory study, we found that surgical revascularization of pelvic and inguinal arteries in IC patients improved certain gait parameters. Further studies with larger patient numbers are needed to confirm these data and provide more evidence on this subject. : Clinical Relevance: Intermittent claudication (IC) includes impaired gait parameters. The influence of arterial disobliteration has rarely been investigated. We examined the gait patterns before and after surgical disobliteration of pelvic and inguinal arteries. Disobliteration improves the painless walking distance; however, its influence on gait parameters is unclear. We hypothesized that the gait parameters would also improve after surgery. Improved parameters could lead to more economic walking, lower oxygen consumption, a lower risk of falls, and a higher quality of life. Revascularization of 20 patients with IC resulted in improved walking cadence (mean, plus 7.88 steps; 95.5 steps/min vs 87.6 steps/min), hip joint mobility (mean, plus 2.0°; 35.1° vs 33.1°), and foot rotation (mean, plus 2.0°; 11.0° vs 9.0°).

Keywords

• Gait analysis
• Peripheral arterial disease
• Surgery