Annals of Vascular Surgery · Oct 28, 2026

Impact of Angiographic Lesion Distribution on Walking Therapy Outcomes in Lower Extremity Artery Disease

By El Kaddouri R, Colle A, Cornelis N et al.

AIM: To investigate whether angiographic lesion distribution and disease severity influence outcomes of walking therapy in patients with lower extremity artery disease (LEAD) and intermittent claudication (IC). METHODS: In this prospective, single-center cohort study, patients with IC participated in a 12-week hybrid progressive walking program consisting of one supervised treadmill session and two home-based walking sessions per week. Baseline evaluation included assessment of ankle-brachial index (ABI), angiographic imaging (CTA or MRA), and functional exercise testing. Pain-free walking distance (PFWD) and maximal walking distance (MWD) were assessed using standardized treadmill protocols. Angiographic lesion distribution was classified according to lesion location, while disease severity was graded using the ANGIO score. RESULTS: Thirty-three patients (mean age 69.1 ± 9.4 years, 75.8% male) with available angiographic imaging were included in the present analysis. After three months, PFWD increased from 173 m to 304 m, an increase of 131 m (p < 0.001), and MWD increased from 448 m to 627 m, an increase of 179 m (p < 0.001). Lesion distribution was not significantly associated with changes in PFWD (p = 0.059), and no statistically significant differences were observed for MWD (p = 0.44). Disease severity, expressed by the ANGIO score, was not correlated with walking improvements (ρ = -0.10, p = 0.57 for PFWD; ρ = 0.10, p = 0.56 for MWD). CONCLUSION: Walking therapy significantly improved walking capacity in patients with LEAD. In this exploratory cohort, no statistically significant associations were observed between angiographic lesion distribution or disease severity and improvements in walking distance. However, the small overall sample size and limited number of patients within several lesion distribution groups preclude firm conclusions regarding the influence of lesion characteristics on treatment response. These findings should therefore be considered hypothesis-generating and warrant confirmation in larger studies.

doi.org/10.1016/j.avsg.2026.10.031PubMed 42951184Interventions