Effects of exercise training on common femoral artery blood flow in patients with intermittent claudication.

Exercise training is a commonly used rehabilitative therapy for patients with intermittent claudication (IC). However, it is not known whether blood flow through the major conduit vessel of the leg, the common femoral artery (CFA), increases with exercise training. We tested the hypothesis that peak CFA blood flow will increase with a supervised, lengthy, and individualized exercise training program. Subjects were 10 IC patients (eight men, two women) with a mean age of 61 +/- 7 (mean +/- SD) years who had either aortoiliac (n = 7) or femoropopliteal (n = 3) stenosis. Using noninvasive Doppler flowmetry, we measured CFA blood flow and ankle pressure at rest and after a maximum symptom-limited graded treadmill test before (T1) and after 3 (T2) and 5 (T3) months of exercise training. Variables were measured in the supine and upright postures at rest and during recovery. Total walking distance and claudication distance on the treadmill were determined for T1, T2, and T3. After training, CFA blood flow and ankle pressure were not significantly higher at rest or at 1 minute after exercise compared with pretraining despite significant increases in claudication and total walking distances. The rate of CFA blood flow recovery was slower at T3, suggesting the accrual of a larger metabolic debt during exercise due to more work performed. We conclude that changes in CFA blood flow are not responsible for measured changes in performance with exercise training in IC patients.

Noninvasive echo-Doppler duplex measurements of common femoral artery blood flow variables during supine exercise and post-occlusive reactive hyperemia.

Noninvasive dynamic measurements of common femoral artery blood flow (CFBF) and stroke volume (CFSV) during supine exercise (SE) and staged post-occlusive reactive hyperemia (PORH) in normal subjects using an echo-Doppler duplex scanner (DS) would provide baseline hemodynamic data in the study of the peripheral circulation in resting, stressed, and diseased conditions. Heart rate (HR), CFBF, and CFSV were determined at rest (R), after 5 minutes of SE on an ergometer (30 rpm) at 30, 60, 90-watt loads and after a 3-minute recovery. The same variables were also calculated after periods of 2-, 5-, and 10-minute thigh occlusions (greater than 240 mm Hg cuff pressure). Measurements of spatial average blood velocities and lumen diameters were used to calculate CFBF. Ankle pressure (AP) and brachial pressure (BP) were determined, and the ratio of systolic AP to systolic BP, the ankle index (AI), was calculated. As in vitro validation of the DS method was accomplished using a hydraulic model of CFBF (r = 0.98). Mean values for maximal CFBF following SE and PORH were 0.81 and 1.53 l/min, respectively. With SE, increases in CFBF and CFSV and decreases in AI were significantly (p less than .05) only at 60- and 90-watt loads. Increases in CFBF and CFSV and decreases in AP and AI were significantly different (p less than .05) from rest for the three occlusion durations and show a linear trend. This study suggests that the DS method can noninvasively and quantitatively measure CFBF and CFSV at rest following SE and during PORH.