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PubMedDate not supplied

Pentoxifylline--a new drug for the treatment of intermittent claudication.

Pentoxifylline, a xanthine analogue was evaluated for efficacy, safety and tolerance in the treatment of intermittent claudication in a pilot study. Evaluation was performed in 35 cases. 20 patients were given Pentoxifylline in doses of 1200 mg daily, and 15 patients were given placebo for a period of 8 weeks respectively. Pentoxifylline given in doses of 1200 mg was significantly more effective than the placebo in increasing both the initial and absolute claudication distance (ICD & ACD) in patients with chronic occlusive arterial disease. The subjective parameters, such as paraesthesias, muscular cramps and sensation of heaviness in the legs paralleled the course of walking parameters. These results support the hypothesis that Pentoxifylline in doses of 400 mg TDS reduces blood viscosity by improving red cell flexibility, and thereby enhances blood flow in patients with COAD (Fontaine Stage II or Stage III). Pentoxifylline is thus regarded as a promising drug for circulatory ischaemic disorders, especially in intermittent claudication. It was well tolerated with minimal untoward effects.

Adult↗
PubMed1984

Intermittent claudication. Current results of nonoperative management.

We reviewed the clinical course of 91 men with mild intermittent claudication who had been followed up for at least six months without operation. During 2.5 years' mean follow-up, 60% of the patients had more severe claudication. Actuarial analysis revealed an annual mortality of 4.5% and an annual operation rate of 9%. Historical factors, including age, race, smoking, exercise, diabetes, hypertension, and the ankle-brachial index (ABI), were analyzed to determine if these variables could predict clinical outcome. Only cigarette smoking, exercise, and the ABI were significant in this regard. Patients who had smoked at least 40 pack-years had an operation rate 3.3 times higher than those who smoked less. Major daily exercise was associated with stable claudication. The initial ABI did not correlate with clinical outcome. A subsequent decrease in the ABI of at least 0.15, however, was associated with an operation rate 2.5 times higher and a symptom progression rate 1.8 times higher than patients without this change in the ABI. When regression analysis was used, the preceding variables were only 63% to 79% accurate in predicting the clinical outcome of individual patients. Careful follow-up of patients with intermittent claudication is therefore recommended to allow timely operative intervention when required.

Adult↗
PubMed1983

Neurogenic intermittent claudication.

Twenty-six patient treated for neurogenic intermittent claudication (NIC) have been examined on an average of 25.5 months after a decompression operation. Twenty-two of the patients were either considerably better (15 patients) or completely free of symptoms (7 patients). Pre-operatively two thirds of the patients were able to walk less than a 100 metres. Post-operatively 12 of the patients had an unlimited walking distance.

Adult↗
PubMed1987

Influence of pentoxifylline on muscle tissue oxygen tension (pO2) of patients with intermittent claudication before and after pedal ergometer exercise.

Ten patients with Stage II chronic arterial occlusive disease (intermittent claudication) took part in a randomized, intraindividual crossover study involving acute intravenous administration of 200 mg pentoxifylline or physiological saline solution (placebo). The tissue oxygen tension (pO2) response (pO2 kinetics) following treatment with placebo revealed a nominal but statistically nonsignificant increase in arithmetic mean and median pO2 immediately after the end of exercise. Values thereafter reverted approximately to the initial values recorded at rest. Comparison of the pooled pO2 histograms during the individual periods before and after the end of exercise, however, revealed a broadening of the histogram base, reflecting both higher pO2 values and, more particularly, increased numbers of hypoxic and anoxic pO2 values. This is interpreted as an expression of nonhomogeneous capillary perfusion (maldistribution). Following administration of pentoxifylline to the same patients, there was a statistically significant increase in mean and median pO2 at ten and twenty minutes after the end of exercise. Even after thirty and sixty minutes, these values were in some cases still clearly higher than the initial preexercise values. Study of the pooled pO2 histograms discloses a right shift compared with the initial preexercise histograms. This suggests that pentoxifylline exerts a positive effect on maldistribution by making capillary perfusion more homogeneous. The results support the conclusion that, in the context of reactive hyperemia after muscular exercise, tissue oxygen supply is markedly improved by pentoxifylline in comparison with saline solution. The measurement of tissue pO2 before and at intervals after pedal ergometer exercise is a new objective technique for assessing the efficacy of blood flow-promoting therapy, permitting close simulation of the pathophysiological situation in the muscles of the lower leg in intermittent claudication.

Arterial Occlusive Diseases↗
PubMed1980

Ischaemic intermittent claudication of the masticatory muscles: two case reports.

Intermittent claudication of the masticatory muscles is an unusual symptom sometimes described in association with temporal arteritis. We describe here two cases where this symptom was due to insufficient blood supply to the masticatory muscles caused by atherosclerotic changes of carotid vessels. In one of our cases surgical revascularization was followed by the disappearance of this symptom.

Arterial Occlusive Diseases↗
PubMed1999

Ergotamine-induced intermittent claudication.

We report about a female patient with intermittent claudication caused by ergotamine. She used ergotamine as a treatment for migraine headaches for more than 4 years. The claudication began 7 month before admission. Colour Doppler sonography and angiography showed severe stenosis of the left external iliac and superficial femoral artery. The patient was treated with phenprocoumon for one year after withdrawal of ergotamine. After that the superficial femoral stenosis disappeared completely, but the external iliac stenosis was still present and was consequently successfully treated by atherectomy. The histology showed a fibrosis of the intima and a hypertrophy of the media.

Adult↗
PubMedDate not supplied

Aortoiliac stent placement in patients treated for intermittent claudication.

PURPOSE: To assess the results of iliac artery stent placement for the treatment of patients with intermittent claudication. MATERIALS AND METHODS: Lesions in 90 iliac arteries were treated in 65 patients with 111 Wallstents and 21 Palmaz stents. Stents were placed for symptoms of intermittent claudication classified as grade I, categories 1-3 by the SVS/ISCVS/SCVIR reporting standards. Sixty-two stenosed arteries and 28 chronically occluded arteries were treated. Patients were followed for up to 57.1 months (mean, 17.4 months +/- 14.9). RESULTS: Technical success was achieved in 87 of 90 iliac limbs (97%), with major complications in seven of 65 patients (11%). The 30-day mortality was zero. Mean pressure gradients across stenoses improved from 14.7 mm Hg +/- 9.8 to 1.4 mm Hg +/- 1.4 (P < .001). Ankle-brachial indices improved from 0.62 +/- 0.21 to 0.90 +/- 0.18 (P < .001). With use of the Rutherford criteria, 84% demonstrated +2 or +3 improvement. The cumulative patency rates were 77%, 71%, 62%, and 62% at 1, 2, 3, and 4 years (standard error [SE] < 10%). Continued clinical and noninvasive test benefit was present in 80%, 80%, 73%, and 73% at 1, 2, 3, and 4 years, respectively (SE < 10%). CONCLUSIONS: Significant hemodynamic improvement can be achieved by percutaneous stent placement, with excellent clinical results. Observed mortality in this series was zero, but major complications, requiring modification of the treatment plan, were seen in 11% of patients. Clinical results were better than suggested using current accepting reporting standards for "patency."

Aorta, Abdominal↗
PubMed1975

The smoking habits of men with intermittent claudication.

Smoking habits among 54 male patients with intermittent claudication (IC) and 200 healthy 50-year-old men from the same county have been studied. The prevalence of smokers at the age of 50 was 98% among the IC patients against 46% among the healthy controls. The percentage of heavy smokers and the total tobacco consumptiion were not significantly different in the two groups. However, the percentage of smokers who began to smoke before the age of 15 was significantly higher in IC patients than in the healthy group, 28% to 7%.

Adult↗
PubMed1993

Fibrinogen in relation to personal history of prevalent hypertension, diabetes, stroke, intermittent claudication, coronary heart disease, and family history: the Scottish Heart Health Study.

OBJECTIVE: To determine the relations of plasma fibrinogen to family history of premature heart disease, personal history of hypertension, diabetes, stroke, coronary heart disease, and to presence of intermittent claudication. DESIGN: Random population survey across 22 local government districts in Scotland. PARTICIPANTS: 10,359 men and women aged 40 to 59 years. Plasma fibrinogen was measured in 8824. MAIN OUTCOME MEASURE: Plasma fibrinogen concentration. RESULTS: Persons with a family history of heart disease or a personal history of high blood pressure, diabetes, stroke, or presence of intermittent claudication all had higher plasma fibrinogen concentrations than those without. When compared with participants without cardiovascular or related disease (men: 2.27 (SE = 0.01) g/l, n = 3367; women 2.34 (0.01) g/l, n = 3096), predefined cases of either myocardial infarction (men: 2.51 (0.02) g/l, n = 248; women: 2.63 (0.04) g/l, n = 72) or angina (men: 2.45 (0.02) g/l, n = 394; women: 2.50 (0.02) g/l, n = 398) had significantly higher plasma fibrinogen concentrations (p < 0.001). After adjustment for 10 other coronary risk factors, there was a noticeable linear trend in the odds ratios for myocardial infarction across all quartiles (quarters) of plasma fibrinogen concentrations in both sexes. Similarly, the risk of angina increased linearly with increasing fibrinogen concentrations, although the test for a linear trend was NS among women. CONCLUSIONS: This large population study confirms that plasma fibrinogen is not only a risk factor for coronary heart disease and stroke, but it is also raised with family history of premature heart disease and with personal history of hypertension, diabetes, and presence of intermittent claudication.

Adult↗
PubMed2003

Efficacy and safety of cilostazol, a novel phosphodiesterase inhibitor in patients with intermittent claudication.

Pharmacotherapy is limited for the relief of intermittent claudication (IC), a common manifestation of peripheral arterial disease (PAD). Pentoxyfylline, the only current pharmacological therapy for IC, has been shown to have similar efficacy as placebo. Cilostazol, a new phosphodiesterase III (PDE III) inhibitor, is a potent inhibitor of platelet aggregation with vasodilatory, antithrombotic, antiproliferative and positive lipid-altering effects. To evaluate the efficacy and safety of cilostazol for the treatment of IC in Indian patients, 123 patients were selected from 6 centres in India. The patients, aged 58-73 years, with the diagnosis of stable moderate-to-severe IC received cilostazol 100/50 mg twice daily for a period of 12 weeks. Primary efficacy measures included initial claudication distance (ICD) and absolute walking distance (ACD) by treadmill testing and ankle-brachial index (ABI) using Doppler ultrasonography-measured systolic pressures. Secondary efficacy outcomes included subjective assessment of symptom improvement by patient and investigator and estimation of lipid values. Adverse events were monitored throughout the study. Laboratory investigations were carried out at baseline and end of study. At the end of week 12 of cilostazol therapy, there was a significant improvement in the raw walking distances (ICD and ACD). Percentage change in ICD and ACD was 46.77% and 64.5%, respectively, at the end of study. There was a significant increase (32.7%) in the ABI by the end of study period. According to patient and investigator assessment of symptoms, 58-60% of the subjects showed significant improvement to complete resolution of claudication symptoms by the end of 12 weeks of therapy. In addition, there was a significant increase of 20.24% in the mean plasma HDL-cholesterol levels and a decrease of 29.55% in the mean plasma triglyceride concentrations by the end of study period. Headache, diarrhoea, palpitation and dizziness were the commonly reported adverse effects during the study. No adverse effect led to discontinuation of therapy. The present study suggests that cilostazol is an effective therapeutic option with an acceptable tolerability profile for the treatment of IC in patients with PAD.

Aged↗
PubMed1978

Intermittent claudication: prevalence and risk factors.

Risk factors for intermittent claudication (IC) were studied in 54 patients--that is, all patients with IC on the lists of two general practices--and 108 controls. Smoking was the factor most strongly associated with the development of IC, but systolic and diastolic blood pressures and concentrations of triglyceride, urate, and fibrinogen were all significantly higher among the patients with IC than the controls. The presence of more than one factor appeared to be associated with a multiplicative increase in risk. Cholesterol, an important risk factor for ischaemic heart disease, was not associated with an increased risk of IC. IC was present in about 2% of the men and 1% of the women, who were aged 45-69 years. These findings suggest that IC, a common and disabling manifestation of atheroslcerosis, may be largely preventable.

Aged↗
PubMed1996

Evaluation of the coagulation and fibrinolytic systems in men with intermittent claudication.

The authors evaluated elements of the coagulation and fibrinolytic systems in 18 male patients with intermittent claudication vs 19 men matched for risk factors who served as controls. Prothrombin time and activated partial thromboplastin time did not significantly differ in the patients and the controls. The plasminogen level in the two groups was not significantly different. The level of lipoprotein(a) was significantly higher in the patients than in the controls. The levels of antigen and the activity of protein C did not differ significantly between the two groups. The thrombomodulin level was significantly higher in the patients than in the controls. There were no significant differences between the two groups in the levels of alpha 2-macroglobulin, C1-inactivator, or antithrombin III. The levels of fibrinogen and alpha 1-antitrypsin were significantly higher in the patients vs the controls. Significantly lower levels of alpha 2-plasmin inhibitor and higher levels of alpha 2-plasmin inhibitor/plasmin complex and thrombin/antithrombin III complex were found in the patients vs the controls. These findings suggest that the levels of thrombin/antithrombin III complex, alpha 2-plasmin inhibitor/plasmin complex, and thrombomodulin may perhaps serve as indicators for injury to the peripheral endothelium and that the coagulation and fibrinolytic systems may be activated in patients with intermittent claudication.

Aged↗
PubMed1986

Natural history of intermittent claudication in the Japanese.

The natural history of intermittent claudication (IC) was surveyed in 59 limbs of 44 patients. The mean follow-up period was 3 years (1 to 8.3 years). During the follow-up period, 72.0 per cent of the limbs with a solitary arterial lesion improved or remained unchanged. However, detailed analysis showed that 53.3 per cent of limbs with iliac artery stenosis and 50.0 per cent of those with femoropopliteal artery stenosis worsened, whereas only 18.7 per cent of limbs with iliac artery occlusion and no limbs with femoropopliteal artery occlusion had worsening of symptoms. Of limbs with multiple arterial lesions, 62.5 per cent worsened. Although the natural history of IC is relatively favorable, IC due to a solitary arterial stenosis tends to worsen, whereas IC due to a solitary arterial occlusion will, in more than 80 per cent of cases, improve or remain unchanged. In cases of arterial stenosis, therefore, more careful follow-up, including control of risk factors, is mandatory.

Aged↗
PubMed2006

Relationship between soluble thrombomodulin in patients with intermittent claudication and critical ischemia.

INTRODUCTION: Thrombomodulin (TM) has been described as a marker of endothelial injury in atherosclerosis. The role of TM as a predictor of PAD severity is to be proven. The goal of the present study is to compare the level of plasmatic (TMp) in patients with intermittent claudication with patients with critical ischemia in the lower limbs. MATERIALS AND METHODS: TMp was measured using ELISA in the plasma of 41 patients with intermittent claudication degree 1 and in 40 patients presenting critical ischemia in the lower limbs degrees 2 and 3, according to TASC. The hypotheses of normality and homogeneity of the variance had been proven via Shapiro-Wilk and Levene tests, respectively. The comparison of the TMp between the groups was done using the t-Student test. RESULTS: No statistically significant difference was observed. The average levels of TMp for intermittent claudication were 5.2 ng/ml (0.78-13.61 ng/ml) and TMp for critical ischemia in the lower limbs were 6.34 (0.82-18.22 ng/ml) where p=0.265. CONCLUSION: TMp does not seem to be an appropriate marker for PAD severity.

Aged↗
PubMed2001

Treatment of intermittent claudication with pentoxifylline and cilostazol.

The pathophysiology of intermittent claudication (IC) and the role of pentoxifylline and cilostazol for treating IC are discussed. IC, a result of inadequate blood flow to the musculature, is the primary symptom of occlusive peripheral vascular disease (PVD). Patients with IC often have a decreased quality of life because of mobility limitations. PVD is a sign of generalized atherosclerosis and increases the risk of cardiac morbidity and mortality. Smoking, hypertension, diabetes mellitus, and increasing age may hasten the progression of PVD. Strategies for treating IC are aimed at improving symptoms and reducing the progression of atherosclerosis and include risk-factor modification, exercise, and antiplatelet therapy. Cilostazol and pentoxifylline are the only two drugs with FDA-approved labeling for use in treating IC. Both drugs have been shown to increase pain-free walking time and total distance walked, although there is some conflicting evidence for pentoxifylline. Cilostazol and pentoxi-fylline are fairly well tolerated; the most common adverse effects involve the gastrointestinal tract and central nervous system. Inhibitors of cytochrome P-450 isoenzymes 3A4 and 2C19 should be used cautiously in patients taking cilostazol, and this drug is contraindicated in patients with congestive heart failure. Cilostazol is more costly than pentoxifylline. Initiation of therapy with either pentoxifylline or cilostazol may be reasonable if risk-factor modifications, lifestyle changes, and antiplatelet therapy are not effective. The mainstays of therapy for IC are risk-factor modification, exercise, and antiplatelet therapy. If these prove inadequate, treatment with pentoxifylline or cilostazol may be reasonable.

Aged↗
PubMed1982

Lactate and pyruvate changes during treadmill exercise in patients with intermittent claudication.

Exercise and post-exercise metabolism was studied in the legs of 6 healthy individuals without arterial occlusive disease and in 34 patients with intermittent claudication. Venous blood from the popliteal vein was taken intermittently by regional catheterization during and after an exhaustive constant load exercise on a treadmill. Change of lactate and pyruvate was studied in arterial and popliteal venous blood. The mean arterial concentration of pyruvate during exercise was increased less in patients and controls as compared to the lactate concentration in both groups. There was a continuous rise of the arterial pyruvate concentration after exercise in patients in contrast to the controls. During exercise, the difference between the arterio-popliteal venous blood samples in lactate concentrations was significantly higher in patients than in the controls. In general, patients had a significantly higher lactatepyruvate ratio in the popliteal venous blood than in the arterial blood. It is concluded that the onset and degree of anaerobic work is best studied by the regional catheterization technique. This new technique permits to study the spontaneous and reactive metabolic changes in the legs during and after treadmill exercise in patients with intermittent claudication.

Adult↗
PubMed2001

Model of neuropathic intermittent claudication in the rat: methodology and application.

In the present study we characterize a rat neurogenic intermittent claudication model which was accomplished by placing two pieces of silicone rubber of various sizes into the lumbar (L4 and L6) epidural space. After induction of spinal stenosis walking function was measured using a treadmill apparatus and sensory functions were tested by measuring thermal and tactile withdrawal threshold (von Frey filaments) for the period of 28 days after stenosis. In addition, local spinal cord blood flow (SCBF) was measured, periodically, before and after induction of stenosis using laser Doppler. After implantation of two pieces of silicone rubber (width 1.25 mm, height 1.0 mm, length 4.0 mm) a significant running dysfunction, as evidenced by shortening of running distance, was measured as soon as 24 h after stenosis (178.5+/-59.1 m vs 681.3+/-70.2 m). This effect persisted for 28 days after surgery. Similarly, a significant tactile (but not thermal) hypersensitivity was measured for a period of 28 days (1.2+/-0.3 g vs 14.9+/-0.2 g). In this experimental group the measurement of local SCBF revealed a significant (30-50%) reduction in the territory of spinal stenosis measured at 3,7,14 or 28 days after surgery. Implantation of larger pieces of silicon rubber (1.5 mm width) caused a significant increase in the incidence of urinary retention and mortality rate. These data show that chronic partial spinal compression at L4 and L6 spinal level lead to the development of significant motor/sensory dysfunction which resemble those seen in patients with neurogenic intermittent claudication. The lack of motor dysfunction under resting conditions but its appearance during forced exercise also suggest that the development of local spinal ischemia can represent one of the mechanisms.

Animals↗
PubMed1998

Prediction of peak oxygen consumption in patients with intermittent claudication.

Determination of peak oxygen consumption (VO2peak) is considered important for assessing a patient's functional capacity and for exercise prescription. However, the equipment necessary to obtain accurate determination of VO2peak is not always available in clinical settings. The present study sought to develop an equation to estimate VO2peak in peripheral arterial occlusive disease (PAOD) patients with intermittent claudication and to determine independent predictors of VO2peak in this population. One hundred and fifty-seven patients with intermittent claudication were assigned to either a validation group (n = 105) or a cross-validation group (n = 52). Medical history, height, weight, body mass index (BMI), age, gender, smoking status, resting and postexercise ankle/brachial systolic pressure index (ABI), and time to maximal claudication pain and maximal heart rate from an incremental graded exercise test (GXT) were used as potential independent predictors of VO2peak. Time to onset of maximal claudication pain, maximal heart rate, and BMI were all independently associated with VO2peak. These variables were used to estimate VO2peak by the following equation: VO2peak (mL/kg/min) = (0.00872 x maximal claudication pain time [sec]) + (0.02839 x maximal heart rate [b/min]) - (0.12034 x BMI) + 10.11411 r = 0.71, r2 = 0.50, standard error of estimate = 2.02 mL/kg/min, p < 0.0001There was no significant difference between the estimated and actual VO2peak in the cross-validation group, and the coefficient of variation between estimated and actual VO2peak in this group was 18.3%. There was no significant difference between the correlation coefficient for the relationship between estimated and actual VO2peak in the cross-validation group (r = 0.61) and the multiple correlation coefficient from the validation group (r = 0.71). Results of this study suggest that a multiple regression equation can be used to estimate VO2peak in patients with intermittent claudication by measuring time to maximal claudication pain and maximal heart rate from a GXT and by measuring BMI.

Aged↗