On the 8th of June 2026 Kadri Eerik will defend her thesis „Effects of remote ischaemic preconditioning on functional capacity and vascular and biochemical-metabolic biomarkers in patients with lower extremity artery disease”.
Supervisors:
Professor of Vasology Jaak Kals, University of Tartu
Professor of Cardiology Jaan Eha, University of Tartu
Research Fellow in Cardiology Teele Kasepalu, University of Tartu
Research Fellow in Statistical Genomics Mart Kals, University of Tartu
Oponent:
Professor Anders Gottsäter, Lund University (Sweden)
Summary:
Lower extremity artery disease (LEAD), also known as peripheral artery disease (PAD), is a manifestation of systemic atherosclerosis that leads to narrowing or obstruction of the lower limb arteries and impaired blood supply to the legs. One of its most common clinical forms is intermittent claudication (IC), characterised by exercise-induced calf pain that is relieved by rest. IC forces patients to stop walking, limits daily physical activity, and significantly reduces quality of life. In addition, LEAD is associated with a markedly increased risk of cardiovascular morbidity and mortality.
The aim of this doctoral thesis was to investigate whether a novel, non-invasive treatment strategy, remote ischaemic preconditioning (RIPC), could benefit patients with IC. RIPC involves brief, controlled episodes of ischemia in a distant organ (typically the arm) to activate the body’s endogenous protective mechanisms and potentially increase the affected leg’s tolerance to reduced blood flow. A randomised, sham controlled, double-blind clinical trial was conducted to evaluate the effects of daily RIPC over 28 days on walking capacity and quality of life in patients with IC. In addition to clinical outcomes, the study assessed the effects of RIPC on arterial stiffness, biomarkers of cardiac and renal injury, inflammation, oxidative stress, and metabolome.
A total of 42 male patients with IC participated in the study. Participants performed daily RIPC sessions at home using an automated device resembling a blood pressure cuff. Outcomes were compared with a control group using an identical device that did not induce ischemia. Adherence was excellent, and the intervention proved safe and well-tolerated. Despite this, RIPC did not improve walking distance or quality of life, nor did it significantly affect arterial stiffness or biomarkers of organ injury, inflammation, oxidative stress, or metabolism.
In conclusion, although RIPC is safe and easy to administer, it did not provide meaningful clinical benefit in LEAD patients with IC. It is possible that these patients are already “preconditioned” due to chronic leg ischaemia, limiting any additional effect. Based on these findings, routine use of RIPC in IC cannot be recommended. Larger multicentre studies are needed to explore whether specific patient subgroups might benefit.
