Vascular
rehabilitation’
s concept in
peripheral
vascular
disease
Sri Safariawati Maidina Asyahrul Afif
Meity Ardiana
Introduction
Vascular
Peripheral Venous disease
Rehabilitation
artery disease
>200 million global CVD 15–80% global • Lifestyle changes
population (52,23% population, Varicous vein • Exercise therapy
women vs. 47,77% man) 2-73% global population • Social and pshycology
support
Gul F, Janzer SF. Peripheral Vascular Disease. [Updated 2023 Jun 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
Ethiology & Risk Factor of
Ethiology
PAD Risk Factor
decreased blood flow of major • tobacco use
Progressive
organs and ischemia of end • diabetes mellitus
atherosclerotic
organs • hypertension
• HIV
• Dyslipidemia
• age over 50
• high homocysteine
levels
• BMI over 30
• family history of
cardiovascular
disease.
Hamburg NM, Balady GJ. Exercise rehabilitation in peripheral artery disease: functional impact and mechanisms of benefits. Circulation. 2011 Jan
4;123(1):87-97. doi: 10.1161/CIRCULATIONAHA.109.881888.
Ethiology & Risk Factor of
Venous Disease
Ethiology Risk Factor
• Vein Valve • age over 50
incompetence • Obesity
• Vein Hypertension • Women (due to pregnancy)
• Genetic • Tobacco uses
predisposision or • sedentary habits
aging (vein wall • jobs that require prolonged
weakness) standing or sitting
• Hypertension
• Diabetes millitus
• Heart disease
• Hypercoagulable disease
(Lupus, clotting factor
Singh A, Zahra F. Chronic Venous Insufficiency(Archived) [Updated 2023 Apr 27]. In: StatPearls deficiency)
[Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan- • family history of venous
disease.
Vascular Rehabilitation for
PAD
Lifestyle Exercise Complement
changes Therapy ary therapy
• Smoking cessation, • Walking exercise • Hydrotherapy and
• dietary changes (30-45 min thermotherapy
• management of persession with (Heat therapy)
risk factors total 35 session in • Social and
(diabetes, 12 weeks). psycological support
hypertension, and • Aerobic exercise
dislipidemia) with ergometer (20
min persession
twice a week in 6
month)
Perdigão, K. F. A., Costa, L. P., Freitas, A. L., De Morais Lima, J. H., De França, E. É. T., & Pedrosa, R. (2025). Vascular rehabilitation interventions in
people with peripheral arterial disease: an integrative review. Jornal Vascular Brasileiro, 24. https://doi.org/10.1590/1677-5449.202400882
Vascular Rehabilitation for Venouse
disease
Caggiati, A., De Maeseneer, M., Cavezzi, A., Mosti, G., & Morrison, N. (2018). Rehabilitation of patients with venous diseases of the
lower limbs: State of the art. Phlebology the Journal of Venous Disease, 33(10), 663–671. https://doi.org/10.1177/0268355518754463
Vascular Rehabilitation for Venouse
disease
Caggiati, A., De Maeseneer, M., Cavezzi, A., Mosti, G., & Morrison, N. (2018). Rehabilitation of patients with venous diseases of the
lower limbs: State of the art. Phlebology the Journal of Venous Disease, 33(10), 663–671. https://doi.org/10.1177/0268355518754463
The role of exercise in improving
blood circulation and endothelial
function Exercise
Exercise
benefits in
benefits in
Venous
PAD
• Increasing angiogenesis and The blood disease
return from the lower limbs
collateral growth--> blood flow
>>>>> the vis a tergo (blood
propulsion by residual Any kind
capillary pressure) exercise and
• Enhance skeletal muscle
physical activity
metabolism and mitochondrial
function • Plantar
the vis a latere (blood
correction
acceleration by
• Ankle
• Increased endothelial nitric oxide muscular pumping)
rehabilitation
synthase expression & activation
• Calf pump
endothelial function>>>
the vis a fronte • Gait Re-
(thoraco-abdominal education
• Surpressing inflamatory activation (C- Respiratory
blood aspiration)
reactive protein,IL-6, and soluble vascular Exercise
cellular adhesion molecule-1 (sVCAM-1)
Bearne LM, Volkmer B, Peacock J, et al. Effect of a home-based, walking exercise behavior change intervention vs usual care onwalking in adults with
peripheral artery disease: the MOSAIC randomized clinical trial. JAMA. 2022;327(14):1344-55.http://doi.org/10.1001/jama.2022.3391.
A Multidisciplinary Approach in Vascular
Rehabilitation
Revascularization team
Medical management team
• Cardiologist (intervention
• General practitioner
sub)
• Cardiologist
• Radiologist (intervention
• Nutritionist
sub)
• Vascular surgeon
Multidisciplinary
Team
Wound care team
Rehabitiation team
• Vascular surgeon
• Psychologists
• Wound care nursing
• Physiotherapists and
• Orthopedist
occupational
• Podiatris
therapists
Naveh, S, Rogers, R, Hess, C. et al. Multidisciplinary Management of Chronic Limb Threatening Ischemia. J Am Coll Cardiol Case Rep. 2024 Dec, 29 (23)
Dhand S. Multidisciplinary Approach to PAD: Who's on Your Team? Semin Intervent Radiol. 2018 Dec;35(5):378-383. doi: 10.1055/s-0038-1676094.
Epub 2019 Feb 5. PMID: 30728653; PMCID: PMC6363554.
Conclusion
Vascular rehabilitation is a comprehensive
approach that combines exercise therapy
with lifestyle changes to effectively manage
vascular disease, in addition to
psychological and social support is needed
especially for patients who experience
barriers to activity. Rehabilitation with
various exercises can increase blood flow,
improve endothelial function, and suppress
inflammatory activation. This certainly
makes the symptoms of vascular disease
improve and improves the quality of life of
patients.
Referrence
Bearne LM, Volkmer B, Peacock J, et al. Effect of a home-based, walking exercise behavior change intervention vs usual care onwalking in adults with
peripheral artery disease: the MOSAIC randomized clinical trial. JAMA. 2022;327(14):1344-55.http://doi.org/10.1001/jama.2022.3391.
Caggiati, A., De Maeseneer, M., Cavezzi, A., Mosti, G., & Morrison, N. (2018). Rehabilitation of patients with venous diseases of the lower limbs: State of
the art. Phlebology the Journal of Venous Disease, 33(10), 663–671. https://doi.org/10.1177/0268355518754463
Dhand S. Multidisciplinary Approach to PAD: Who's on Your Team? Semin Intervent Radiol. 2018 Dec;35(5):378-383. doi: 10.1055/s-0038-1676094.
Epub 2019 Feb 5. PMID: 30728653; PMCID: PMC6363554.
Gul F, Janzer SF. Peripheral Vascular Disease. [Updated 2023 Jun 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
Hamburg NM, Balady GJ. Exercise rehabilitation in peripheral artery disease: functional impact and mechanisms of benefits. Circulation. 2011 Jan
4;123(1):87-97. doi: 10.1161/CIRCULATIONAHA.109.881888.
McDermott MM. Exercise Rehabilitation for Peripheral Artery Disease: A REVIEW. J Cardiopulm Rehabil Prev. 2018 Mar;38(2):63-69
Naveh, S, Rogers, R, Hess, C. et al. Multidisciplinary Management of Chronic Limb Threatening Ischemia. J Am Coll Cardiol Case Rep. 2024 Dec, 29 (23)
Patel SK, Surowiec SM. Venous Insufficiency. [Updated 2024 Feb 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-
Perdigão, K. F. A., Costa, L. P., Freitas, A. L., De Morais Lima, J. H., De França, E. É. T., & Pedrosa, R. (2025). Vascular rehabilitation interventions in
people with peripheral arterial disease: an integrative review. Jornal Vascular Brasileiro, 24. https://doi.org/10.1590/1677-5449.202400882
Singh A, Zahra F. Chronic Venous Insufficiency(Archived) [Updated 2023 Apr 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;
2025 Jan-
Zemaitis MR, Boll JM, Dreyer MA. Peripheral Arterial Disease. [Updated 2023 May 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2025 Jan-
