The aim of this study is to investigate the effect of different treatment strategies on mitochondrial function and to correlate in-vitro results to findings from in-vivo measurements of mitochondrial function. The authors hypothesize that interventional revascularization and therefore the restoration of blood and oxygen supply is more relevant to mitochondrial function compared to the effect of exercise training.
Resulting from a chronic narrowing of arteries by atherosclerotic lesions, the leading clinical symptom of peripheral arterial disease (PAD), a walking induced pain, reduces quality of life of patients. Affected muscle regions are altered by a characterized myopathy and mitochondria are known to play a crucial role in this pathophysiological mechanism. There are different methodological approaches to investigate mitochondrial function in-vivo as well as in-vitro. Regarding our own preliminary data, mitochondria are known to recover after successful revascularization. The effect of different treatment strategies on mitochondrial function and the correlation of in-vitro to clinical more applicable in-vivo methods was understudied so far. The overall aim of this study is to investigate the effect of different treatment strategies on mitochondrial function and to correlate in-vitro results to findings from in-vivo measurements of mitochondrial function. The authors hypothesize that interventional revascularization and therefore the restoration of blood and oxygen supply is more relevant to mitochondrial function compared to the effect of exercise training. Patients with isolated pathologies of the superficial femoral artery and symptomatic PAD (Fontaine stage IIB) will be included and randomized to different treatment groups (conservative treatment versus interventional revascularization). Near-infrared refracted spectroscopy and the TIVITA ® hyperspectral camera will be used for in-vivo measurement of peripheral oxygen saturation and distal perfusion before and after an exercise. Muscle biopsies will be obtained from affected (gastrocnemius muscle) as well as from unaffected muscle (lateral vastus muscle) shortly before and 12 weeks after initiating treatment. Muscle samples will be investigated by measurement of CSA regarding mitochondrial content and HRR regarding mitochondrial respiration as well as for oxidative stress.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
NONE
Enrollment
80
Depending on the exact morphology of the lesion, patients with short superficial femoral artery lesions (\<25 cm) will be subdivided into group 2A with endovascular treatment (percutaneous transluminal angioplasty with or without stenting) and patients with long superficial femoral artery lesions (\>25 cm) will be subdivided into group 2B with open surgical treatment (femoropopliteal bypass) .
Home-based monitored exercise training (walking), 3 times a week, monitored with log book and activity sensors.
Medical University Innsbruck
Innsbruck, Tyrol, Austria
RECRUITINGChange in mitochondrial function after defined treatment
High-resolution respirometry of muscle biopsy sample
Time frame: After 12 weeks - compared to baseline at inclusion
Change of near infrared spectroscopy
Near infrared spectroscopy measurement of calf
Time frame: After 12 weeks - compared to baseline at inclusion
Change in flow mediated dilation of the brachial artery
Evaluation of endothelial dysfunction with ultrasound measurements of flow mediated dilation of the brachial artery.
Time frame: After 12 weeks - compared to baseline at inclusion
Change in standardized 6-minutes walking test
Evaluation of cardiovascular risk with measurement of maximal walking distance (meters) in 6 minutes.
Time frame: After 12 weeks - compared to baseline at inclusion
Change in ankle-brachial index
Evaluation of hemodynamic parameters (ankle-brachial index).
Time frame: After 12 weeks - compared to baseline at inclusion
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