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PubMedDate not supplied

Effects of policosanol and ticlopidine in patients with intermittent claudication: a double-blinded pilot comparative study.

Policosanol is a cholesterol-lowering drug with concomitant antiplatelet effects. The present study was undertaken to compare the effects of policosanol and ticlopidine in patients with moderately severe intermittent claudication (IC). The study had a 4-week baseline step, followed by a 20-week double-blinded, randomized treatment period. Twenty-eight eligible patients were randomized to policosanol 10 mg or ticlopidine 250 mg tablets twice daily (bid). Walking distances in a treadmill (constant speed 3.2 km/hr, slope 10 degrees, temperature 25 degrees C) were assessed before and after 20 weeks of treatment. Both groups were similar at baseline. Compared with baseline, policosanol significantly increased (p < 0.01) mean values of initial (ICD) and absolute (ACD) claudication distances from 162.1 to 273.2 m and from 255.8 to 401.0 m, respectively. Ticlopidine also raised significantly (p < 0.01) ICD (166.2 to 266.3 m) and ACD (252.9 to 386.4 m). Comparisons between groups did not show significant differences. Policosanol, but not ticlopidine, significantly (p < 0.05), but modestly, increased the ankle/arm pressure ratio. After 10 weeks, policosanol significantly (p < 0.001) lowered low-density lipoprotein-cholesterol (LDL-C), total cholesterol (TC) (p < 0.01), and TC/HDL-C and raised (p < 0.05) high-density lipoprotein-cholesterol (HDL-C). At study completion, policosanol lowered (p < 0.001) LDL-C (30.2%), TC (16.9%), and TC/HDL-C (33.9%), increased (p < 0.01) HDL-C (+31.7%), and left triglycerides unchanged. Ticlopidine did not affect the lipid profile variable. Policosanol induced modest, but significant, reductions (p < 0.01) of fibrinogen levels compared with baseline and ticlopidine. Treatments were well tolerated and did not impair safety indicators. Three ticlopidine patients (21.4%) withdrew from the trial, only 1 owing to a serious adverse experience (AE) (unstable angina). Three other ticlopidine patients experienced mild AE (headache, diarrhea, and acidity). It is concluded that policosanol (10 mg bid) can be as effective as ticlopidine (250 mg bid) for improving walking distances of claudicant patients, and it could be advantageous for the global risk of these individuals owing to its cholesterol-lowering effects. This study is, however, just a pilot comparison, so that further studies in larger sample sizes are needed for definitive conclusions of the comparative effects of both drugs on patients with IC.

Adult↗
PubMedDate not supplied

Effect of propionylcarnitine on changes in endothelial function and plasma levels of adhesion molecules induced by acute exercise in patients with intermittent claudication.

In patients with intermittent claudication, treadmill exercise may cause acute deterioration of endothelial function and increase in plasma concentrations of adhesion molecules. The authors evaluated the efficacy of intravenously administered propionylcarnitine (PLC)in preventing these phenomena. Thirty-six claudicants with postexercise decrease in brachial artery flow-mediated dilation (FMD)were randomized to either placebo or PLC (600 mg as a single bolus followed by 1 mg/kg/min for 60 minutes).In the 18 patients randomized to placebo, FMD markedly decreased with exercise before (from 6.8 +/-0.4% to 4.0 +/-0.4%; p < 0.001) and after treatment (from 6.5 +/-0.4% to 4.4 +/-0.5%; p < 0.001). By contrast, in the PLC group, FMD significantly decreased with exercise before treatment (from 8.0 +/-0.7% to 4.4 +/-0.4%; p < 0.001), but not after active drug administration (from 7.1 +/-0.7% to 6.0 +/-0.6%; p = 0.067). The difference between treatments was not significant (p = 0.099; ANOVA). However, in the PLC group, the authors found that the greater the exercise-induced deterioration in endothelial function before treatment, the greater the capacity of PLC to prevent a postexercise decrease in FMD (r = -0.50, p = 0.034). Accordingly, they analyzed data in the 19 patients with a baseline exercise-induced decrease in FMD >or=45% (ie, the median FMD reduction in the entire group of 36 patients), and found that the exercise-induced FMD decrease was less after PLC than after placebo (p = 0.046, ANOVA). In the same subgroup, the exercise-induced increase in plasma concentrations of soluble vascular cell adhesion molecule-1 (sVCAM-1) was significantly higher before than after treatment in patients randomized to PLC (23.4 +/-5% vs 15.3 +/-7%, p = 0.007). In conclusion, in patients with intermittent claudication suffering from a greater endothelial derangement after treadmill, PLC administration provided a protective effect against deterioration of FMD and increase of sVCAM-1 induced by exercise.

Biomarkers↗
PubMedDate not supplied

Cramps and muscular pain: prevention with pycnogenol in normal subjects, venous patients, athletes, claudicants and in diabetic microangiopathy.

The aim of this study was to assess the preventive action of Pycnogenol (Horphag Research Ltd, UK) on cramps and muscular pain in different groups of subjects and patients. The study included a 5-week observation period (4 weeks treatment and one follow-up week after the suspension of treatment) to evaluate the efficacy of Pycnogenol after its withdrawal. Four 50 mg capsules (total dose 200 mg/day) were prescribed with suggestion to drink at least 1.5 liters of water every day. In the first part of the study 66 healthy subjects completed a 5-week follow-up period. The difference between number of cramps attacks recorded within the 2 weeks before inclusion and the number of episodes during the fourth (p <0.05) and fifth (p <0.05) week were statistically significant. In normal subjects the average number of episodes was reduced from 4.8 (1.2) events per week to 1.3 (1.1) at 4 weeks (p <0.05). In venous patients the decrease in events was from 6.3 (1.1) to 2.6 (0.4) per week (p <0.05). In athletes the number of episodes decreased from 8.6 (2) to 2.4 (0.5) (p <0.05). The decrease was still present at 5 weeks in the 3 groups, to levels significantly lower than inclusion values (p <0.05). In the second part of the study, patients with intermittent claudication and diabetic microangiopathy were evaluated and treated (4 weeks). The groups treated with Pycnogenol and the control, placebo groups were comparable. There was a significant decrease in the number of cramps episodes (p <0.05) and in the score concerning muscular pain (p <0.05) in claudicants and diabetics. No significant effects were observed in the placebo groups. In conclusion, cramps and muscular pain, common in these 2 types of patients, were decreased by the use of Pycnogenol. Globally, these results suggest that the use of Pycnogenol prevents cramps, muscular pain at rest, and pain after/during exercise in normals, in athletes prone to cramps, in patients with venous disease, in claudicants, and in diabetics with microangiopathy. The difference is statistically significant considering objective observations (cramps episodes) and evaluating more subjective aspects (score). This indicates that Pycnogenol is effective in reducing pain and cramps during retraining and rehabilitation increasing its efficiency. In starting any physical rehabilitation program, particularly in vascular subjects, the limitation in mobility associated with muscular pain and with cramps tends to be relevant, and controlling these symptoms is useful to speed up the retraining process.

Adult↗
PubMed1980

Fibrositic myofascial pain in intermittent claudication: significance of trigger areas in the calf.

To test the hypothesis of a myofascial component in intermittent claudication, 56 male patients were studied. Calf blood flow, at rest and during postischemic and postexercise hyperemia, presence of trigger areas, and exercise tolerance were evaluated and compared. The results can be summarized as follows: The exercise tolerance is reduced when trigger areas are present in the calf muscles, and the more severe the trigger areas, the lower is the exercise tolerance. Trigger areas are more severe when the hyperemic flow is more reduced. The peak flow of reactive hyperemia is also correlated to work load. Pain in intermittent claudication is a complex phenomenon. According to the aforesaid results, the severity of limb ischemia and the presence of trigger areas in the calf appear to be the major factors. Besides the two reasons already known, a third is suggested to explain calf claudication: the elective location of trigger points in the gastrocnemius muscle.

Aged↗
PubMed1980

Blood flow measurement in patients with intermittent claudication.

Modified isotope clearance tests for the objective investigation of intermittent claudication of the lower limb were performed in 14 normal subjects with clinically patent arteries and 9 patients with calf claudication and arteriographically confirmed peripheral vascular occlusion. The tests involved a standard exercise performed in the supine position. During rest periods the limb under test was subjected to simultaneous venous occlusion plethysmography. In the patients with intermittent claudication, results were abnormal when compared with those of the normal group. The modified testing procedure described gave discriminatory results for each group. Their usefulness in monitoring disease progression, treatment benefit, and patient selection for surgery is discussed.

Adult↗
PubMed1986

Continuous measurement of transcutaneous oxygen tension on stress test in claudicants and normals.

Subjective evaluation of hemodynamics by stress tests in claudicants should be made to establish severity of functional ischemia. As an indispensable examination of vascular laboratory, non-invasive, simple methods can only satisfy methodological conditions. The aim of this study was to apply the transcutaneous oxygen tension measurement for a non-invasive, continuous detector of hemodynamic responses in skin circulation by stress tests and to elucidate the clinical usefulness of this technique. Investigated were 20 legs in patients with intermittent claudication and 9 legs in healthy persons as controls. Ten legs with ischemic pain during exercise loading revealed abnormal transcutaneous oxygen tension (tcPO2) curves in comparison with those with in normal legs. Over the continuous tcPO2 curve, the minimum tcPO2 at the reverse postural change after exercise loading was the most reliable indicator for evaluating induced ischemia. We conclude that hemodynamic responses on stress tests should be analyzed both during and after exercise loading, and that the continuous tcPO2 curve constitutes a useful method for evaluating and following up the claudicants.

Adolescent↗
PubMed1987

Placebo-controlled trial of ketanserin in the treatment of intermittent claudication.

The effect of ketanserin on the symptoms of 21 patients with stable intermittent claudication was examined in a double-blind, placebo-controlled, parallel-group study. Benefit was assessed by repeated treadmill exercise tests, recording claudication and total walking times. After three months' treatment with ketanserin (mean dose 167 mg/day) there was no significant change in claudication time (mean change + 12%, 95% CI -9; + 33%) or total walking time (mean change -14%, 95% CI -47%; + 19%). The confidence intervals show that ketanserin treatment is unlikely to be associated with clinically important improvement.

Blood Pressure↗
PubMed1989

Increase of walking capacity after acute aminophylline administration in intermittent claudication.

In the presence of peripheral atherosclerotic disease, inappropriate adenosine release during exercise might promote excessive arteriolar dilation leading to steal phenomena and ischemia. In order to test this hypothesis, IV aminophylline (6 mg/kg over fifteen minutes), a dosage known to effectively block adenosine receptors, was acutely administered--in a double-blind, placebo-controlled study design--in 13 patients with intermittent claudication and documented atherosclerotic disease. All patients performed two treadmill exercise tests at the same hour on two consecutive days, five minutes after aminophylline or placebo administration randomly allocated. Pain-free time was 109 +/- 133 (mean +/- SD) seconds after placebo and 173 +/- 165 seconds after aminophylline (p less than .01); maximum time to claudication was 273 +/- 191 seconds after placebo and 397 +/- 318 seconds after aminophylline (p less than .05). The authors conclude that intravenous aminophylline markedly increases the walking capacity in patients with intermittent claudication, possibly by preventing flow maldistribution phenomena through adenosine receptors blockade.

Aminophylline↗
PubMed1993

Functional benefits of peripheral vascular bypass surgery for patients with intermittent claudication.

Many patients with peripheral arterial disease (PAD) undergo peripheral bypass surgery to relieve the symptom of intermittent claudication. However, measurement of graft patency alone, assessed by change in ankle blood pressure, may not adequately reflect the improvement in functional status following the operation. Fourteen patients with moderately severe intermittent claudication were evaluated before and after bypass surgery to asses changes in hemodynamics (by resting ankle-brachial indices-ABIs), exercise performance (by a graded treadmill protocol), and community-based walking ability (by a questionnaire that characterizes self-reported walking speed and distance). Six weeks after surgery, resting ABIs improved in surgical patients (from 0.56 +/- 0.09 to 0.93 +/- 0.16, P < 0.05). Peak treadmill walking time improved from 6.2 +/- 5.9 to 11.8 +/- 7.1 min (90%), peak oxygen consumption from 15.5 +/- 6.5 to 19.1 +/- 8.5 mL/kg/min (23%), and pain-free walking time from 1.5 +/- 0.4 to 6.0 5.5 min (290%). Questionnaire scores for walking distance improved by 203% and for walking speed by 130% (all P < 0.05). After twelve weeks, improvements other than pain-free walking time were maintained. Changes in peak treadmill performance or questionnaire scores were not correlated with the initial ABI, changes in ABI six or twelve weeks after surgery, or the type or extent of bypass surgery. The results demonstrate that surgical treatment of PAD, indicated for the relief of intermittent claudication, improves exercise performance and self-reported community-based walking ability. The change in functional status of the patient is an important outcome of surgery that cannot be predicted from routine noninvasive testing alone and should be measured directly.

Aged↗
PubMed1994

Comparative evaluation of pentoxifylline, buflomedil, and nifedipine in the treatment of intermittent claudication of the lower limbs.

In the light of the current controversy surrounding the use of hemorheologic and vasodilator drugs in the treatment of peripheral arteriosclerosis, a comparative study was designed in order to evaluate the efficacy of pentoxifylline, buflomedil, and nifedipine in 45 patients with peripheral arterial disease (Fontaine stage II). The patients in this prospective randomized study were divided into three groups: 15 patients received pentoxifylline treatment (1,200 mg/day), 15 were treated with buflomedil (600 mg/day), and 15 with nifedipine (60 mg/day). Response to treatment was assessed at the start of the study and after forty-five and ninety days, by clinical examination, Doppler test, strain test, and digital occlusion plethysmography using a strain gauge ring. Pentoxifylline was significantly more effective (P < 0.05) than buflomedil and nifedipine at ninety days in improving walking performance, resting toe pressure, resting and postexercise ankle/brachial pressure ratio, and basal/postischemic toe-pulse ratio. Significant differences within groups were also noted for initial claudication, toe peak-flow time, pulse reappearance time (PRT/2), and maximum postischemic flow time, together with significant intergroup variables. In conclusion, pentoxifylline proved more effective than the other drugs tested in: 1. improving distal pressure and resting microcirculatory blood flow; 2. increasing postexercise distal flow, ratios, and pressures and enabling faster recuperation of basal pulse rates; 3. increasing initial claudication distance in the strain test within the test group and achieving a greater absolute subjective claudication distance than that obtained using the other treatments.

Adult↗
PubMed1995

Comparative diagnostic value of ankle-to-brachial index and transcutaneous oxygen tension at rest and after exercise in patients with intermittent claudication.

BACKGROUND: Few studies have compared sensitivities of ankle-to-brachial index (ABI) and transcutaneous oxygen tension (TcPO2) in a large group of patients with Leriche stage II intermittent claudication. METHOD AND RESULTS: 111 patients (138 limbs) with a stable chronic (> three months) intermittent claudication and significant peripheral vascular disease (PVD) proved by angiography were studied. They performed a treadmill test (10%, 3 km/hr) limited by limb pain. ABI and TcPO2 were measured before, just after exercise, and after three and ten minutes of recovery in supine position. Sensitivities per patient for ABI and TcPO2 were respectively at rest: 82.9% and 28.8%, and after exercise: 88.3% and 62.2%. Sensitivities per leg (n = 138) for ABI and TcPO2 were respectively at rest: 73.9% and 26.8%, and after exercise: 82.6% and 34%. The sensitivity of TcPO2 increased to 56.5% after three minutes of recovery but was always less than that of ABI, which was maximal just after exercise (82.6%). The sensitivity of the regional perfusion index was similar to that of TcPO2. The sensitivity of TcPO2 increased with respect to the Leriche stage and the number of lesions but was always lower than that of ABI. There was a weak correlation between TcPO2 and ABI after exercise, but no correlation was noted between maximal walking distance, ABI, and TcPO2. CONCLUSION: TcPO2 is not required in patients with Leriche stage II intermittent claudication but might be useful either in severely affected patients (Leriche stage III or IV) or in selected patients.

Aged↗
PubMed1997

Successful treatment of intermittent claudication due to spinal canal stenosis using beraprost sodium, a stable prostaglandin I2 analogue. A case report.

The syndrome of intermittent claudication can be induced not only by vascular insufficiency of the lower limbs but also by diseases of the spinal cord and cauda equina. The authors describe a sixty-year-old man with intermittent claudication due to spinal canal stenosis who was successfully treated with beraprost sodium, a stable prostaglandin I2 analogue. This drug has a long biological half-life and is orally effective in vasodilation, which is suggested to be beneficial in treating this syndrome. Beraprost sodium may become one of the major drugs for conservative therapy of intermittent claudication induced by spinal canal stenosis.

Epoprostenol↗
PubMed1998

A placebo-controlled study of the effects of intravenous Buflomedil on foot skin microcirculation in patients with severe intermittent claudication.

Buflomedil hydrochloride (Buflomedil), a vasoactive drug, has been proven to improve pain-free walking distance in patients with peripheral arterial occlusive disease stage II of the lower extremities. In the present double-blind, randomized study, resting skin flux motion activity and skin flux response to a local heat stress at the hallux were assessed by laser Doppler fluxmetry (LDF) in claudicants. Twenty of 39 enrolled patients with severe intermittent claudication received a daily intravenous dose of 400 mg Buflomedil, and the other 19 patients received 0.9% NaCl as placebo over a 5-day period. Before treatment mean LDF skin resting flux, flux frequency, and flux amplitude were 2 +/- 0.8 Arbitrary Units (AU), 8.4 +/- 0.5 cycles per minute (c/min), and 0.12 +/- 0.01 AU, respectively in the Buflomedil group, and 2.3 +/- 0.3 AU, 8.7 +/- 0.7 c/min, and 0.13 +/- 0.02 AU in the placebo group (NS). Also the response to heat stress was identical in both groups: a slow initial increase of skin flux, followed by a reflex reduction, with a maximal initial flux increase to 138 +/- 12% of the resting value in the Buflomedil group, and 155 +/- 16% in the placebo group (NS). After 5 days of treatment the mean LDF skin resting flux, flux frequency, and flux amplitude were unchanged in both patient groups. The response to heating on the contrary was dramatically enhanced in the Buflomedil group (226 +/- 33%), against that in the placebo group, which remained unchanged (144 +/- 13%) after 3 minutes (P < 0.05), while after reflex reduction the flux in the Buflomedil group remained stable at 200% of resting value during further heating and was only approximately 140% in the placebo group (P < 0.05). It is concluded that Buflomedil, administered in a daily intravenous dose of 400 mg, does not alter the mean LDF skin flux and flux motion at the hallux in claudicants in resting conditions. Local skin heating on the contrary provokes a significant LDF-monitored skin flux increase, suggesting an improved capacity of cutaneous microvessel perfusion in stressed conditions.

Aged↗
PubMed1998

Intermittent claudication and risk of cardiovascular events.

To determine the natural history of intermittent claudication, 110 patients were followed up for a mean period of 24.4 +/- 1.2 months. Four patients died during the follow-up. Of the survivors, 24 experienced a nonfatal cardiovascular event, myocardial infarction being the most frequent. Cumulative cardiovascular morbidity was 29% at 3 years. Cox proportional-hazards analysis showed initial ankle-brachial pressure index (ABPI) as a significant predictor for nonfatal cardiovascular events (p<0.002). With an initial ABPI >0.70, cardiovascular morbidity rate was 12% compared with 33% for those with initial ABPI ranging from 0.70 to 0.50, and 60% for those with ABPI <0.50 (p<0.005). Critical limb ischemia occurred in only four patients, amputation was required in two, and arterial reconstruction in five. Of the 85 patients who participated in the treadmill test, maximum walking capacity worsened in 26% and improved in 27%. This study elucidates the neglected area of cardiovascular morbidity in intermittent claudication. It has shown that ABPI identifies a subgroup of patients for whom the risk of cardiovascular events is especially pronounced. On the other hand, based on objective evaluation of the patient status, the relatively benign prognosis for the claudicant limb has been confirmed.

Female↗
PubMed1998

Comparison of three blood pressure methods used for determining ankle/brachial index in patients with intermittent claudication.

The standard noninvasive test to assess the severity of peripheral arterial occlusive disease (PAOD) is the ankle/brachial systolic blood pressure index (ABI). While ankle systolic blood pressure is obtained by the Doppler ultrasound technique, brachial systolic blood pressure can be obtained by the Doppler, auscultatory, or oscillometric (Dinamap 1846 SX) methods. The purpose was to determine whether the three methods yielded similar brachial systolic blood pressure values, and consequently similar ABI values, in PAOD patients with intermittent claudication. Fifty patients who had a history of intermittent claudication of 2.3 +/- 2.0 blocks for a duration of 5.7 +/- 5.8 years were recruited. Following 10 minutes of supine rest, brachial systolic blood pressure was measured in the right arm by the three techniques in a randomized order, and ankle systolic blood pressure (87.3 +/- 28.9 mmHg) was measured in the more symptomatic leg with the Doppler technique. Brachial systolic blood pressure was not significantly different (p=0.954) among the Doppler (128.5 +/- 18.4 mmHg), auscultatory (128.4 +/- 17.4 mmHg), and oscillometric (128.2 +/- 17.1 mmHg) methods. Corresponding ABI values also were similar (p=0.922) among the three respective methods (0.68 +/- 0.22, 0.68 +/- 0.22, and 0.68 +/- 0.21), indicating that ABI did not vary according to the technique used to obtain brachial systolic blood pressure. It is concluded that the accuracy of determining ABI in PAOD patients with intermittent claudication was minimally affected by the method chosen to obtain brachial systolic blood pressure.

Aged↗
PubMed1999

Relationship between free-living daily physical activity and peripheral circulation in patients with intermittent claudication.

The purpose of this study was to determine the relationship between free-living daily physical activity and peripheral circulation under resting, reactive hyperemia, and maximal exercise conditions in peripheral arterial occlusive disease (PAOD) patients with intermittent claudication. Sixty-one PAOD patients (age = 70 +/- 6 years, ankle/brachial index [ABI] = 0.57 +/- 0.24) were recruited from the Vascular Clinic at the Baltimore Veterans Affairs Medical Center and from radio and newspaper advertisements. Free-living daily physical activity was measured as the energy expenditure of physical activity (EEPA), determined from doubly labeled water and indirect calorimetry. Patients also were characterized on ankle/brachial index, calf blood flow, calf transcutaneous oxygen tension (TcPO2), and calf transcutaneous heating power (TcHP). ABI and calf blood flow served as markers of the macrocirculation of the lower extremity, while TcPO2 and TcHP served as markers of the microcirculation. The claudication patients were sedentary, reflected by a mean EEPA value of 486 +/- 274 kcal/day. EEPA was related to calf TcHP at rest (282 +/- 24 mW; r = -0.413, p = 0.002), after postocclusion reactive hyperemia (275 +/- 22 mW; r = -0.381, p = 0.004), and after maximal exercise (276 +/- 20 mW; r = -0.461, p<0.001). ABI, calf blood flow, and calf TcPO2 were not related to EEPA under any condition. In conclusion, higher levels of free-living daily physical activity were associated with better microcirculation of the calf musculature in older PAOD patients with intermittent claudication.

Activities of Daily Living↗
PubMed1999

The effect of cigarette smoking status on six-minute walk distance in patients with intermittent claudication.

The purposes of the study were threefold: (1) to compare 6-minute walk performance as a measure of exercise tolerance among three different groups of peripheral arterial occlusive disease (PAOD) patients with intermittent claudication-current smokers, former smokers, and patients who have never smoked; (2) to identify important covariates that might affect the relationship between smoking and exercise in the PAOD population; (3) to determine whether differences among the three groups in 6-minute walk performance persist after statistically controlling for the significant covariates. Recruited into the study were 415 PAOD patients with intermittent claudication between the ages of 42 and 88 years. The self-reported smoking status consisted of 182 current smokers, 196 former smokers, and 37 patients who had never smoked. The authors recorded 6-minute walk distance, a reliable measurement of exercise tolerance in PAOD patients, as well as age, body composition, self-reported ambulatory function, self-reported physical activity, and standard peripheral hemodynamics. Nonsmokers walked significantly farther (413 +/- 14 m; mean +/- standard error) and took more steps (665 +/- 14 steps) than either current (352 +/- 7 m; 563 +/- 9 steps) or former smokers 370 +/- 7 m; 600 +/- 8 steps) (p<0.05). The nonsmokers had a higher ankle-brachial index (ABI) value (0.70 +/- 0.03) than patients who actively smoked 0.62 +/- 0.01 (p<0.03); the authors observed an inverse relationship between smoking history and self-reported physical activity (WIQ Distance Score: nonsmokers 51 +/- 6%, former smokers 38 +/- 3%, and smokers 32 +/- 2%) (p<0.01). From a multivariate perspective, ABI, physical activity, and perceived walking ability were the only independent predictors of 6-minute walk distance. Differences in the adjusted 6-minute walk distance among the nonsmokers (388 +/- 13 m), current smokers (359 +/- 6 m), and former smokers (368 +/-6 m) no longer remained after controlling statistically for these covariates. The findings suggest that 6-minute walk distance is a sensitive measure to detect differences in submaximal exercise performance between smoking and nonsmoking PAOD patients with intermittent claudication. Moreover, the group difference in the 6-minute walk distance is explained by group differences in walking perception, PAOD severity, and physical activity level.

Adult↗
PubMed2004

Long term outcome of femoropopliteal bypass for claudication and critical ischemia.

We performed 167 femoropopliteal bypass surgeries in 151 patients (95 patients underwent above-knee bypass and 56 below-knee bypass) from December 1985 to December 2000 with the use of prosthetic graft or autologous vein graft. We compared primary patency rates between age, sex, graft material, distal anastomotic site and severity of ischemia, considering their survival rates to elucidate the long-term outcome of above-knee and below-knee femoropopliteal bypass. The 10 year patency rate for above-knee bypass was 47.4%, compared to 36.9% for below-knee ( p < 0.01). Better results were found after bypass surgery for claudicants than for critical ischemia ( p < 0.05). With regard to graft material and age categories, there were unexpectedly no statistical differences in either above-knee or below-knee anastomosis. The survival rate at 10 years in claudicants was 51.2%, compared to 15.9% with critical ischemia ( p < 0.01). Mortality was much influenced by ischemic heart disease ( p < 0.002) and the age of patient ( p < 0.05). The results after above-knee bypass had comparable patency, whereas the results after below-knee bypass were disappointing. Below-knee arterial reconstruction for claudicants should be carefully considered and might be recommended only to patients with critical ischemia.

Age Factors↗