Effect of Buerger-Allen Exercises on Lower Extremity Perfusion in Diabetes Mellitus Patients Undergoing Coronary Artery Bypass Grafting With Saphenous Vein Harvesting: a Randomized Controlled Trial

BACKGROUND & PURPOSE: Patients with diabetes mellitus undergoing coronary artery bypass grafting (CABG) with saphenous vein harvesting are at increased risk of impaired lower extremity perfusion and wound‐related complications. Buerger‐Allen exercises have been proposed to improve peripheral circulation; however, evidence supporting their effectiveness following CABG remains limited. This study evaluated the effect of Buerger‐Allen exercises as an adjunct to phase I cardiac rehabilitation on lower extremity perfusion and wound healing in diabetic patients undergoing CABG. METHODS: A randomized controlled trial was conducted involving 60 diabetic patients undergoing CABG with saphenous vein harvesting. Participants were randomly allocated to an intervention group receiving standard phase I cardiac rehabilitation plus Buerger‐Allen exercises (n = 30) or a control group receiving standard rehabilitation alone (n = 30). The primary outcome was ankle‐brachial index (ABI). Secondary outcomes included wound healing disturbances and peripheral ankle swelling. Postoperative ABI was analyzed using two‐way repeated‐measures ANOVA, whereas categorical outcomes were analyzed using Fisher's exact test or the Chi‐squared test. RESULTS: A significant effect of time on ABI was observed (p = 0.004), whereas neither the group effect (p = 0.754) nor the group × time interaction (p = 0.711) was statistically significant. An earlier resolution of mild wound‐related pain was observed on postoperative day 3 in the intervention group (p = 0.038); however, no between‐group differences were present on postoperative day 5. No intervention‐related adverse events were reported. DISCUSSION: Buerger‐Allen exercises were safe and feasible during early postoperative rehabilitation but did not provide additional improvement in lower extremity perfusion beyond standard rehabilitation during the 5‐day postoperative period. The isolated improvement in wound‐related pain should be interpreted cautiously. CONCLUSION: Buerger‐Allen exercises did not significantly improve the primary outcome of lower extremity perfusion following CABG. Although they appeared safe and were associated with transient improvement in wound‐related pain, further adequately powered studies with longer follow‐up are required to determine whether clinically meaningful benefits exist. TRIAL REGISTRATION: This study was prospectively registered in the Clinical Trial Registry India (CTRI/2023/10/058535).