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At least 307 records · Page 17Linked to original sources
PubMed2003

Evaluation of buttock claudication with hypogastric artery stump pressure measurement and near infrared spectroscopy after abdominal aortic aneurysm repair.

OBJECTIVE: We explored the usefulness of intraoperative measurement of hypogastric artery (HGA) stump pressure (HGA-SP) and postoperative near infrared spectroscopy (NIRS) in evaluating buttock claudication (BC) after abdominal aortic aneurysm (AAA) repair. DESIGN: Retrospective clinical study. PATIENTS AND METHODS: Twenty patients who were undergoing AAA repair were enrolled. The HGA was ligated bilaterally in 5 patients, unilaterally in 12, and preserved in 3. The HGA-SP was measured intraoperatively. Postoperatively, NIRS was used to evaluate buttock muscle ischemia during walking. RESULTS: Six patients had unilateral and 1 bilateral BC after AAA repairs. The median HGA-SP brachial pressure index (HBI) was 0.62 (range: 0.45-0.64) in 8 claudicating buttocks and 0.76 (range: 0.63-0.90) in 13 asymptomatic buttocks (p < 0.0005). The HBI was <0.65 in all claudicating buttocks, whereas it was >0.63 in asymptomatic buttocks. In all 8 claudicating buttocks, NIRS showed the ischemic pattern with recovery time lasting more than 240 s. CONCLUSIONS: An HBI below 0.65 may be a predictor of BC after AAA repair. NIRS appears to be a useful noninvasive method for evaluating BC after AAA.

Aged↗
PubMed2006

Brace treatment of spinal claudication in an adolescent with a grade IV spondylosisthesis--a case report.

UNLABELLED: Although spinal claudication may arise from spondylolisthesis, little information exists about successful conservative treatment of this condition. However there are studies describing pain reduction due to physiotherapy and bracing. Significant improvement of walking distance and pain intensity in an adolescent with scoliosis, spondylolisthesis and spinal claudication while wearing a delordosing spondylogic brace is presented here. MATERIAL AND METHOD: A 14 year old girl with a 25 degrees thoracic scoliosis (2 years postmenarchial), grade IV spondylolisthesis and spinal claudication underwent treatment with a delordosing spondylogic brace. Walking distance without brace was at around 300 steps before intolerable pain appeared. Self reported walking distance was recorded in the brace 14 days after adjustment. RESULTS: Walking distance increased to an unlimited number of steps after 14 days while pain intensity decreased three points in the VRS. However, no correction effect of the orthosis on the degree of slippage was found. CONCLUSIONS: Although there is evidence that pain in patients with spondylolithesis can be reduced using exercises and bracing in mild to moderate symptomatic cases, this case demonstrates that bracing can also improve signs and symptoms of spinal claudication in patients with spondylolisthesis of higher degrees. A prospective case series study seems desirable.

Adolescent↗
PubMed2003

Evaluation of walking capacity over time in 500 patients with intermittent claudication who underwent clinical treatment.

BACKGROUND: The use of physical training in the treatment of intermittent claudication is well established. However, current data do not provide enough information about the prognosis for each case, and there are no data on how walking distances evolve over time with conservative treatment. The goal of this study was to evaluate improvement in walking capacity among patients with intermittent claudication who underwent unsupervised clinical treatment, observing whether sustained treatment would increase or decrease maximum walking distance, whether after 6 months there was a change in the maximum distance, and whether abstinence from smoking and well-conducted walking exercise had independent effects on the outcome. METHODS: Five hundred patients with intermittent claudication were surveyed in a prospective, nonrandomized, and uncontrolled study. Maximum walking distance and treatment compliance over time were analyzed. RESULTS: Nonsmoking patients who walked achieved a mean increase during the first 6 months of 33.70 m/mo and a mean increase thereafter of 4.24 m/mo. Smokers who walked achieved an increase during the first 6 months only (mean, 42.92 m/mo). Patients who did not practice physical training exhibited no effect (smokers) or negligible effect (nonsmokers) from the treatment (mean, 7.58 m/mo). CONCLUSIONS: Patients who adhered to physical training exhibited a significant increase in maximum walking distance during the first 6 months of treatment only. Patients who did not practice physical training exhibited no effect (smokers) or negligible effect (ex-smokers) from the treatment.

Comorbidity↗
PubMed1980

Femoropopliteal bypass grafting for intermittent claudication: is pessimism warranted?

From 1965 to 1979, 43 consecutive patients underwent 51 femoropopliteal reconstructions to relieve disabling claudication. This represented 17% of 298 femoropopliteal and femorotibial reconstructions performed by the same surgical team during this period of time. All patients operated on for claudication experienced relief of symptoms after surgery. There was no operative mortality and there was only one case of immediate graft failure. Cumulative graft patency was 93% at two years and 88% at five years by life table analysis. One patient who underwent below-knee amputation 12 years after his initial femoropopliteal graft was the only patient who lost a limb at any time during the follow-up period. On the basis of this experience, we now offer femoropopliteal grafting to any active individual who is disabled by intermittent claudication on the basis of superficial femoral artery occlusive disease.

Adult↗
PubMed1988

Femoropopliteal reconstruction for claudication. The risk to life and limb.

The current study was undertaken to examine the results of femoropopliteal bypass grafting with intermittent claudication as the indication. Of 1173 infrainguinal reconstructions carried out on our service during the past decade, 249 (21%) consecutive femoropopliteal grafts were performed for disabling claudication in 191 patients. The primary five-year cumulative patency rates were 78% for autogenous vein and 52% for polytetrafluoroethylene grafts. There were two (0.8%) 30-day operative deaths and a subsequent five-year amputation rate of 2.4% for both groups. Femoropopliteal reconstruction for claudication may therefore be carried out with acceptably low operative mortality and a subsequent amputation rate comparable with that anticipated from the natural history of the disease. While the five-year patency rate is significantly higher utilizing autogenous vein grafts, symptomatic relief may be expected with prosthetic grafts in approximately half the patients without incurring a higher risk of limb loss.

Adult↗
PubMed2000

Angioplasty (versus non surgical management) for intermittent claudication.

BACKGROUND: Intermittent claudication is pain in the legs due to muscle ischaemia associated with arterial stenosis or occlusion. Angioplasty is a technique that involves dilatation and recanalisation of a stenosed or occluded artery. OBJECTIVES: The objective of this review was to determine the effects of angioplasty of arteries in the leg when compared with non surgical therapy, or no therapy, for patients with mild to moderate intermittent claudication. SEARCH STRATEGY: The reviewers searched the Cochrane Peripheral Vascular Diseases Group trials register and reference lists of relevant articles. The reviewers also contacted investigators in the field and hand searched recent conference proceedings. SELECTION CRITERIA: Randomised trials of angioplasty for mild or moderate intermittent claudication. DATA COLLECTION AND ANALYSIS: One reviewer extracted data and both reviewers assessed trial quality independently. MAIN RESULTS: Two trials with a total of 98 participants were included. The average age was 62 years old with 20 women and 789 men. Patients were followed for 15 months in one trial and six years in another. At six months of follow up, mean ankle brachial pressure indices were higher in the angioplasty groups than control groups (weighted mean difference 0.17, 95% confidence interval 0.11 to 0.24). In one trial, walking distances were greater in the angioplasty group, but in the other trial, in which controls underwent an exercise programme, walking distances did not show a greater improvement in the angioplasty group. At two years of follow up in one trial, the angioplasty group were more likely to have a patent artery (odds ratio 5.5, 95% confidence interval 1.8 to 17.0) but not a significantly better walking distance or quality of life. In the other trial, long term follow up at six years demonstrated no significant differences in outcome between the angioplasty and control groups. REVIEWER'S CONCLUSIONS: These limited results suggest that angioplasty may have had a short term benefit, but this may not have been sustained.

Angioplasty, Balloon↗
PubMed2004

Prostanoids for intermittent claudication.

BACKGROUND: Peripheral arterial occlusive disease (PAOD) is a common cause of morbidity in the general population. While numerous studies have established the efficacy of prostanoids in PAOD stages III and IV the question of the role of prostanoids as an alternative or additive treatment in patients suffering from claudicatio intermittens (PAOD II) has not yet been clearly answered. OBJECTIVES: The aim of this review was to evaluate effects of prostanoids in patients with intermittent claudication. SEARCH STRATEGY: Computerised searches of the Cochrane Peripheral Vascular Diseases Specialised Register (last searched April 2003), The Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 1, 2003), MEDLINE and EMBASE were undertaken. In addition relevant journals were hand-searched. SELECTION CRITERIA: Randomized clinical trials describing the effects of prostanoids in the treatment of patients suffering from intermittent claudication have been considered for inclusion. DATA COLLECTION AND ANALYSIS: All reviewers assessed the quality of studies and extracted data unblinded. Statistical analysis including tests for heterogeneity and overall effect were performed by using MetaView of Review Manager 4.2. All numeric values are expressed as mean +/- Standard deviation (SD). MAIN RESULTS: Eighteen studies were included for analysis. A significant heterogeneity between the included studies was detected in most of the subgroup analysis. Five studies compared the effects of prostaglandin E1 (PGE1) versus placebo, and reported in their individual results significant increases in walking distances after the administration of PGE1. The attained increase in walking distances appears to be not merely a short-term effect because several studies reported that walking capacity remained increased even after termination of treatment. On the other hand, oral or intravenous prostacyclin did not increase the walking distances significantly. At least one adverse reaction was reported from 23.6% of the patients treated with prostacyclin (PGI2), and its analogues and from 13.7% of the patients treated with PGE1. REVIEWER'S CONCLUSIONS: Because of the heterogeneity between most of the included studies, we did not pool relevant parts of the data by meta-analysis. Based on the individual results of the published literature, patients with intermittent claudication seem to benefit from administration (intravenous or intra-arterial) of PGE1 by a significant improvement of their walking capacity. Further well-conducted randomized, double blinded trials, with a sufficient number of patients to provide statistical powerful information, should be performed to confirm the results of this review.

Alprostadil↗
PubMed2004

Omega-3 fatty acids for intermittent claudication.

BACKGROUND: Omega-3 fatty acids are established as being effective in the treatment and prevention of coronary artery disease. It is possible that they may also benefit people with peripheral arterial disease, since the pathogenesis of the two conditions is similar. OBJECTIVES: To determine the effects of omega-3 supplementation in people with intermittent claudication. SEARCH STRATEGY: Trials were identified from the Cochrane Peripheral Vascular Diseases Group trials register (last searched April 2004), and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 1, 2004). In addition, literature from pharmaceutical companies (Roche Pharmaceuticals and Seven Seas), manufacturers of omega-3 rich foods (Columbus Eggs) and web sites of nutritional organisations dedicated to omega-3 fatty acids (Omega-3 information and the Fish Foundation) were searched. SELECTION CRITERIA: Randomised controlled trials of omega-3 fatty acids versus placebo or non-omega-3 fatty acids in people with intermittent claudication. DATA COLLECTION AND ANALYSIS: One reviewer (TS) identified potential trials, assessed study quality and extracted data. The other reviewer (WH) assessed study quality and checked data extraction. MAIN RESULTS: Four studies were included involving a total of 203 participants. The overall methodological quality of studies was good. All studies compared omega-3 fatty acid supplementation with placebo. Two studies used an omega-6 fatty acid as the placebo preparation, one used a monounsaturated fatty acid and one used a combination of omega-6 and monounsaturated fatty acids.Omega-3 fatty acid supplementation reduced triglyceride levels (weighted mean difference (WMD) -0.66 mmol/litre; 95% confidence interval (CI) -1.24 to -0.09) and diastolic blood pressure (WMD -1.94 mmHg; 95% CI -3.58 to -0.29) in the treatment group, but increased total cholesterol levels (WMD 0.41 mmol/litre; 95% CI 0.03 to 0.80) and LDL cholesterol levels (WMD 0.43 mmol/litre; 95% CI 0.12 to 0.74). Gastrointestinal side-effects were observed in one study. No significant changes were observed in pain-free walking distance (WMD -17 m; 95% CI -51 to 17 m), maximal walking distance (WMD -21 m; 95% CI -59 to 17 m) or ankle brachial pressure index (WMD -0.03; 95% CI -0.1 to 0.04). REVIEWERS' CONCLUSIONS: Omega-3 fatty acids appear to have some beneficial biochemical and haemodynamic effects in people with intermittent claudication but there is no evidence of improved clinical outcomes. It should be noted that no consistent effect on primary outcome measures was detected. Further research is needed in this area, to evaluate short- and long-term effects on more clinically relevant outcomes.

Dietary Supplements↗
PubMed1975

Phenol sympathectomy in the treatment of intermittent claudication: a controlled clinical trail.

Twenty-five patients with intermittent claudication were randomly allocated to treatment either by injection of phenol into the lumbar sympathetic chain or by injection of local anaesthetic subcutaneously. On the day after the injection, sympathectomy, assessed by skin temperature change, was achieved in 85 per cent of the phenol group. At 1 month subjective improvement was claimed by 45 per cent of the patients in the sympathectomized group and by 64 per cent in the control group; at 3 months the figures were 25 and 45 per cent respectively. Treadmill testing at two exercise loads showed no significant difference in claudication distance or stopping time between the two groups. Calf blood pressure response following exercise was not affected by sympathectomy. There is no subjective or objective evidence that phenol sympathectomy improves intermittent claudication.

Blood Pressure↗
PubMed1985

Atypical claudication.

In a prospective study the incidence, causes and management of atypical claudication have been investigated. All patients had a clinical assessment, Doppler ultrasound studies and X-rays of the lumbosacral spine, some had epidural injections, myelography with computerized axial tomography and arteriography. The incidence of atypical claudication was low, 13 per cent of all claudicants referred to our department, and although difficulties in diagnosis were encountered an approximately equal incidence of spinal and arterial causes was found. Only one patient had a definite central spinal stenosis. The need for invasive investigations was low (18 per cent) and even lower for surgery (7 per cent); the majority of patients' symptoms responded to conservative management.

Arterial Occlusive Diseases↗
PubMed1991

Realistic expectations for the patient with intermittent claudication.

To determine the natural history of intermittent claudication 112 patients were followed for a minimum of 5 years and a median period of 82 months. Thirty-seven patients (33 per cent) died during the study period. Myocardial infarction (44 per cent) and cerebrovascular disease (28 per cent) were the most common causes of death. Overall mortality rate was 8, 23 and 40 per cent, at 2, 5 and 8 years respectively. Initial ankle-brachial pressure index (ABPI) correlated with subsequent death. With an initial ABPI less than 0.5 death occurred in 20, 50 and 69 per cent at 2, 5 and 7 years respectively, compared with 5, 16 and 24 per cent respectively for those with an initial ABPI greater than or equal to 0.5 (P less than 0.0001). Of the survivors only 21 per cent had worsening claudication and 13 per cent progressed to critical ischaemia. Arterial bypass for limb salvage was required in eight patients and four limbs were lost during the study period. ABPI identifies a subgroup of claudicants with an extremely high risk of death from coronary and/or cerebral pathology. In this subgroup an aggressive approach to the correction of atherosclerotic risk factors, rather than emphasis on the peripheral vascular problem alone, may improve survival.

Adult↗
PubMed1992

Reperfusion injury in skeletal muscle: a prospective study in patients with acute limb ischaemia and claudicants treated by revascularization.

A study was carried out to document the occurrence of rhabdomyolysis and renal complications in patients undergoing vascular reconstruction. Indices of muscle damage and renal function were monitored before, during and for up to 10 days after vascular reconstruction for a variety of conditions ranging from intermittent claudication to acute ischaemia. Seven patients with acute limb ischaemia (group 1) and nine with intermittent claudication (group 2) were studied prospectively. In group 1, median creatine kinase (CK) and myoglobin levels were markedly raised 24-48 h after surgery (CK, 29,370 units/l; myoglobin, 8.17 mg/l). Myoglobin reached its peak concentration and declined more quickly than CK, but both indices gave similar information about the extent of muscle damage. In contrast, patients undergoing elective surgery for claudication showed no significant departure from reference values for myoglobin or CK. All patients in group 1 underwent fasciotomy to relieve raised compartmental pressures and five were treated with alkali and mannitol to produce diuresis. Despite these measures, two patients suffered renal failure (peak creatinine levels 611 and 590 mumol/l) after successful revascularization and subsequently required haemodialysis; these patients did not have diuresis. One of these patients died following a stroke 8 days after surgery; the other survived and was discharged with a normal limb and restored renal function. There was no evidence of muscle damage or renal complications in group 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1993

Intermittent claudication incites systemic neutrophil activation and increased vascular permeability.

Reperfusion following severe ischaemia incites a systemic response involving neutrophil activation and vascular injury. Recent work suggests that intermittent claudication may also be capable of inducing similar changes, reversible by revascularization. This observation may have implications for the treatment of claudication and explain the high associated cardiovascular mortality. This hypothesis was investigated using an in vivo model. Rats underwent repeated hindlimb stimulation after common iliac artery ligation. Intravital fluorescence microscopy was used to observe postcapillary venules of the tibialis anterior muscle in the hindlimb. This revealed a bilateral increase in leucocyte-endothelial adhesion and vascular permeability to albumin after unilateral subtotal ischaemia and muscle stimulation, associated with increased urinary albumin excretion. These results provide further evidence supporting the association of intermittent claudication with potentially deleterious systemic manifestations.

Animals↗
PubMed2001

Antioxidants reduce oxidative stress in claudicants.

BACKGROUND: Low-grade ischemia-reperfusion in claudicants leads to damage of local tissues and remote organs. Since this damage is partly caused by oxygen-derived free radicals (ODFR), scavenging these ODFR could reduce the local and remote injury. METHODS: Using a new method by which a free radical reaction product (ortho-APOH) of the exogenous marker antipyrine is measured to quantify the oxidative stress, 16 stable claudicants performed a standard walking test before and after administration of vitamin E (200 mg) and vitamin C (500 mg) daily for 4 weeks. FINDINGS: Ortho-APOH was significantly increased during the reperfusion period (P = 0.026) before administration of the vitamins. After 4 weeks of vitamin supplementation no rise was found in the reperfusion period. Malondialdehyde showed no changes in either group. INTERPRETATION: These findings indicate that administering extra antioxidants to claudicants reduces oxidative stress in these patients. This may also have an effect on the remote ischemia-reperfusion damage and reduce cardiovascular morbidity in this group.

Aged↗
PubMed1995

Benefits of arterial reconstruction in claudication.

We conducted a midterm follow-up of 150 claudicants who underwent surgical reconstruction by assessing cumulative patency, survival, and palliation (graft patency in live patients) rates. Eighty-nine claudicants (group I) underwent direct (in situ) proximal revascularization, 33 (group II) had indirect (ex situ) proximal revascularization, while 28 (group III) had distal revascularization. The secondary patency rates at 3 years were 97.5% in group I, 97.0% in group II, and 75.0% in group III, respectively. Only one patient with limb graft thrombosis required below-knee amputation. There were 3 perioperative deaths (2 in group I and 1 in group II). The survival rates at 3 years were 86.0% in group I, 69.5% in group II, and 95.8% in group III, respectively. The palliation rates at 3 years were 84.8% in group I, 70.0% in group II, and 77.9% in group III, respectively. These findings indicate the midterm benefits of supra- and infrainguinal arterial reconstructions, and also suggest that the preoperative assessment of risks in individual patients, the selection of the appropriate operative procedure and graft material, and intensive postoperative follow-up and management of any associated disease are all important aspects in the treatment of claudicants.

Aged↗
PubMed1993

Claudication in the setting of plethysmographic criteria for resting ischemia: is surgery justified?

Objective noninvasive criteria for resting ischemia are sometimes found in patients with milder clinical complaints. If noninvasive information can predict irrevocable progression to resting ischemia, instances of tissue loss theoretically could be prevented by early intervention. Accordingly, we investigated the clinical outcome in 51 claudicators with pulse volume recorder and/or ankle-brachial index (ABI) criteria for ischemia at rest. Patients with type IV (markedly blunted) or type V (flat) ankle or transmetatarsal pulse volume recordings and/or ABI < 0.5 and accompanying claudication were identified. Resting ischemia and/or tissue necrosis developed in 29% of patients and necessitated vascular reconstruction within 36 months. One patient had a primary above-knee amputation at a different institution and 14 patients underwent successful revascularization. In 3 of 14 patients, reconstruction was accompanied by digit or transmetatarsal amputation. No limbs were lost in the revascularized group. Noninvasive criteria for resting ischemia in patients with claudication alone portend a high rate of progression to resting ischemic symptoms. At present the use of clinical criteria and careful follow-up would permit a high rate of foot and limb salvage in those whose ischemia progresses and would prevent unnecessary surgery in the remaining patients. Further prospective definition of patients at risk for progression of ischemia might help prevent tissue loss in selected patients.

Aged↗
PubMed1996

Femoropopliteal bypass for claudication: vein vs. PTFE.

The vascular graft of choice for femoropopliteal bypass in patients with intolerable claudication is controversial. We retrospectively reviewed our experience with 239 patients suffering from claudication secondary to superficial femoral artery obstruction. Femoropopliteal reconstruction was performed with saphenous vein to the below-knee popliteal artery in 66 patients (BK-vein). Polytetrafluoroethylene (PTFE) was used in 128 patients as a bypass graft to the above-knee popliteal artery (AK-PTFE) and 45 patients had a PTFE graft to the below-knee popliteal artery (BK-PTFE). All patients were enrolled in a postoperative graft surveillance program with graft revision when appropriate. There was one perioperative death (0.4%). Primary patency at 5 years for AK-PTFE, BK-PTFE, and BK-vein was 58.0%, and 60.3%, respectively, and was not significantly different among the graft groups. Graft revision for failed/failing grafts resulted in 5-year secondary patency rates of 79.2% (AK-PTFE), 73.3% (BK-PTFE), and 74.4% (BK-vein). These secondary patency rates were not statistically different. Eventual conversion to a vein graft in patients initially treated with PTFE maximized patency in the femoropopliteal segment with 5-year patency rates of 84.6% and 93.0% for the AK-PTFE and BK-PTFE graft groups, respectively. Major leg amputation was necessary during the entire course of the study in eight (3.3%) patients. We conclude that long-term patency rates for femoropopliteal bypass in patients with intolerable claudication are similar for PTFE and autologous saphenous vein grafts.

Aged↗
PubMed1989

The assessment of pelvic circulation after internal iliac arterial reconstruction: a retrospective study of the treatment for vasculogenic impotence and hip claudication.

The standard surgical treatment of vasculogenic impotence or hip claudication involves repairing vascular lesions, especially in the internal iliac arteries. It is difficult, however, to make a definite diagnosis or an accurate judgement of the therapeutic effects of this treatment due to the trouble in ruling out any other disorders. During the last five years, 19 patients with impotence and associated apparent internal iliac artery stenosis or occlusion and 2 patients with hip claudication, underwent internal iliac arterial reconstruction. The patients' ages ranged from 37 to 70 with a mean age of 63.7 and the main procedure performed in all patients was aorto-iliac to femoral bypass grafting, or abdominal aortic aneurysmectomy. A retrospective study revealed that 74 per cent of those treated regained penile erectile activity postoperatively, and that hip claudication disappeared completely in all cases. One of the patients received percutaneous transluminal angioplasty (PTA) for the treatment of vasculogenic impotence, after which his postoperative penile brachial pressure index (PBPI) improved, demonstrating a statistically significant difference compared to the preoperative value. Trans-anal Doppler measurement also proved useful in providing complication-free perioperative understanding of pelvic circulation.

Adult↗