After exercise or revascularization:

Change in ABI ❌ not associated with walking gains

Change in macrovascular (popliteal artery) post-ischemic inflow ❌ not associated

Change in post-ischemic MICROVASCULAR reactivity ✅ correlated with walking improvement (R=0.46; P=0.014)

✅ ABI, macrovascular inflow, AND microvascular reactivity all correlated with walking distance (6MWT).

In multivariable models, post-ischemic MICROVASCULAR reactivity was strongest (β=825.3, P=0.023).

👩‍🔬 68 participants (50 PAD, 18 controls)

🧪 MRI measures (at rest & after ischemic stimulus):
- Macrovascular (popliteal artery) inflow
- Calf skeletal muscle microvascular reactivity

🚶 6-minute walk test (6MWT)

Subset reassessed after exercise therapy or revascularization

🔎 In PAD, claudication and walking limitation are not fully explained by large artery occlusive disease, as captured by reductions in ABI.

We asked:
Could SKELETAL MUSCLE MICROVASCULAR FUNCTION be the missing link🔗?