Gait Impairments Are Independent Of The Level Of Arterial Occlusive Disease In Claudicating Patients With Peripheral Artery Disease
Sara Myers, PhD1, Todd Leutzinger, MS1, Panagiotis Koutakis, PhD2, Matthew Fuglestad, MD3, Holly Despiegelaere, RN4, Jason Johanning, MD3, Nick Stergiou, PhD1, G. Matthew Longo, MD3, George Casale, PhD3, Iraklis Pipinos, MD3.
1University of Nebraska at Omaha, Omaha, NE, USA, 2Baylor University, Waco, TX, USA, 3University of Nebraska Medical Center, Omaha, NE, USA, 4VA Nebraska-Western Iowa Healthcare System, Omaha, NE, USA.
OBJECTIVES: Different levels of arterial occlusive disease (aortoiliac, femoropopliteal, multi-level disease) can produce claudication symptoms in different leg muscle groups (buttocks, thighs, calves) in patients with peripheral artery disease (PAD). We tested the hypothesis that different levels of occlusive disease uniquely affect muscles of the affected legs and produce distinctive differences in the way patients with claudication walk.
METHODS: 104 patients with PAD and 35 healthy controls participated. Patients with were categorized according to their level of occlusive disease (aortoiliac, femoropopliteal, multi-level disease) using computerized tomographic angiography. Subjects performed walking trials across in-ground force platforms while high speed motion capture data were recorded in pain free and claudicating conditions. Joint kinematics, kinetics, and spatiotemporal parameters evaluating the muscles at the level of the calf, thigh and buttocks were calculated and compared across subject groups. A discriminant analysis was performed in an attempt to classify subjects as PAD patients with a specific level of disease or as controls according to walking parameters.
RESULTS: No significant biomechanical differences were found between PAD groups during the pain free or the claudicating conditions. All statistical differences between subject groups occurred between healthy controls and one or more PAD groups. A discriminant analysis function was able to adequately predict if a subject was a control with over 70% accuracy, but the function had difficulty differentiating between PAD groups.
CONCLUSIONS: In-depth gait analyses indicate that different levels of arterial disease may present with symptoms affecting different leg muscle groups but affect these same muscle groups in a similar fashion that produce similar walking dysfunction in patients with PAD. Several pathophysiologic parameters that have to do with the complicated hemodynamics, neuropathy, myopathy and systemic effects of PAD will need to be further researched to understand these seemingly counterintuitive findings.
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