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PubMedDate not supplied

[Ozone therapy and viscosity of blood and plasma, distance of intermittent claudication and certain biochemical components in patients with diabetes type II and ischemia of the lower extremities].

Blood and plasma viscosity, total blood lipids, triglycerides, total cholesterol, free fatty acids, fibrinogen, hematocrit, and lipidogram were determined in patients with diabetes mellitus type II and coexisting symptoms of the obliterative arteriosclerosis of the lower limbs. Intermittent claudication distance has been measured parallel. The same tests have been carried out after ozone therapy. A significant improvement in the intermittent claudication and reduction in blood and plasma viscosity have been noted. There was statistically significant correlation between intermittent claudication decrease and blood viscosity reduction following ozone therapy.

Aged↗
PubMed1991

[The fate of patients with intermittent claudication--comparison of surgical and non-surgical treatment].

The purpose of this study was to determine the operative indication for patients with intermittent claudication because of arteriosclerosis obliterans, and to compare the late result of the surgical treatment group (130 cases, 175 limbs) with that of the non-surgical treatment group (27 cases, 31 limbs). There were 3 operative deaths and 21 late deaths in the surgical group, and 11 late deaths in the non-surgical group. The number one cause of death was heart failure, including ischemic heart disease, in both groups. The 5-year cumulative patency rate was 92.5% in the aorto-iliac, 70.6% in the femoro-distal and 82.0% in the aorto-femoro-distal arterial reconstructions. Long term symptom free rates of the surgical group and the non-surgical group, except fatal cases, were 87.2% and 25.0% in the aorto-iliac, 57.7% and 25.0% in the femoro-distal, 86.7% and 0% in the aorto-femoro-distal arterial regions, respectively. Late result of intermittent claudication in the surgical group was better than that in the non-surgical group. We conclude that intermittent claudication should be considered to be the indication for surgery, except for the cases with high risk diseases or malignant diseases.

Female↗
PubMed1991

Progressive vs single-stage treadmill tests for evaluation of claudication.

The reliability of claudication pain and the metabolic and hemodynamic measurements of the lower limbs of patients with stable peripheral vascular occlusive disease (PVOD) were compared during and following single-stage (S) and progressive (P) treadmill tests. Ten patients (69.8 +/- 1.8 yr; X +/- SE) walked to maximal claudication pain twice a month for 4 months. Patients walked at 1.5 mph up a 7.5% grade (S test) and at 2 mph on a 0% grade, increasing by 2% every 2 min (P test). Distance walked to the onset of claudication pain (CPD) and maximal walking distance (MWD) were recorded. Foot transcutaneous oxygen tension (TcPO2) was measured before, during, and after exercise, while ankle systolic blood pressure (SBP) and the ankle-to-brachial SBP index (ABI) were measured before and after exercise. Intraclass correlation coefficients (R) of CPD and MWD during S tests were R = 0.53 and R = 0.55, respectively. In contrast, the respective R values during P tests were R = 0.89 and R = 0.93. Higher R values of foot TcPO2 were also obtained during and following P tests, while ankle SBP and ABI were highly reliable following both tests. It is concluded that the severity of PVOD is better assessed by P treadmill tests because clinical measurements are more reliable during exercise and recovery.

Aged↗
PubMedDate not supplied

Some interrelations between blood pressure parameters and claudication distances.

Sixty males and 2 females with the mean age of 58.1 years ranging from 39 to 80 years with atherosclerotic lesions of the arteries of lower extremities were studied. The claudication distance was subdivided into two segments: the first included the distance up to the onset of pain and the second one when the patients had to stop walking because of the severity of pain. The systemic systolic pressure and the poststenotic ankle pressure over both arteries on both calves by a Doppler ultrasound apparatus were measured and the individual pressure gradients were calculated. It was demonstrated that both claudication intervals were related to the poststenotic pressure as well as to the pressure gradient. The stepwise regression analysis showed a significant relationship between both distances and the lowest value of all ankle pressure measurements over four tibial arteries. The closest correlation (R = 0.98) was recorded between the initial and final claudication distance and it persisted even after the elimination of all pressure parameters.

Blood Pressure↗
PubMed1987

Ketanserin in intermittent claudication: effect on walking distance, blood pressure, and cardiovascular complications.

In a 7-center Scandinavian double-blind placebo-controlled study of 179 patients with intermittent claudication, the effect of the serotonin antagonist ketanserin was evaluated on walking distance, brachial and ankle blood pressure, and symptoms. For all centers together, pain-free walking distance was significantly increased after 6 months with both ketanserin (+65%; 71 patients) and placebo (+42%; 78 patients), with no significant difference. However, there was large variability among centers. Classification of "responders" (doubling of walking distance) and patients who deteriorated (decrease of walking distance or dropout for inefficacy) showed significantly more patients responding and significantly fewer patients deteriorating with ketanserin than with placebo. Systemic blood pressure was significantly decreased by ketanserin in hypertensive, but not normotensive, patients, while ankle pressure was unaffected. The incidence and nature of side effects were equal with ketanserin and placebo, but there were more side effects causing dropout in the ketanserin group. An unexpected and possibly important observation was the occurrence of six serious cardiovascular events (myocardial infarction, cerebrovascular complications, and development of rest pain) in the placebo group but none in ketanserin-treated patients. Moreover, there were four additional similar complications in the placebo run-in period. Ketanserin appears to be beneficial in a subgroup of patients with intermittent claudication. A fortuitous finding of this study is that ketanserin might possess a protective effect against thrombovascular complications in patients with intermittent claudication.

Adult↗
PubMed1989

Claudication in young adults: a frequently delayed diagnosis.

Arterial occlusive disease of the lower extremities is uncommon in young adults. Between 1983 and 1988 we undertook an aggressive approach to the diagnosis and treatment of claudication in young patients. Thirty-three patients (30 men and three women) with the onset of significant claudication at age 40 years or younger underwent arteriography after noninvasive evaluation. The mean duration of symptoms was 2 years, and six patients had suffered claudication for 4 years or longer. Atherosclerotic occlusive disease was found in 19 patients (58%), delayed presentation of traumatic occlusion was found in four (12%), congenital arteriopathy was found in four (12%), vasculitis was found in five (15%), and one patient (3%) had normal arteriogram results despite a history and physical examination that suggested inflow disease. Management included percutaneous transluminal angioplasty (PTA) in eight patients (24%) and operative reconstruction in 17 (52%). Seven patients (21%) were treated nonoperatively (five had unreconstructible distal disease and two declined operation). During a mean follow-up of 33 months, three patients who continued to smoke required either repeat PTA or operation for recurrent disease, one patient underwent repeat aortic reconstruction for early operative failure, and one patient with vasculitis required revision of an in situ vein graft for aneurysmal dilatation. The success rates of PTA and surgical reconstruction were encouraging. However, in the group with atherosclerotic occlusive vascular disease, the inability to abstain from smoking suggests a poor prognosis for long-term success.

Adult↗
PubMed1989

[What is the relation between pressure parameters and claudication distance?].

The authors examined the relationship between the ankle pressure, or pressure gradient on the one hand, and the walking distance and different actions, i.e. equalting and standing on tip toes, on the other hand. In 56 male patients with obliterating atherosclerosis, the first stage showed both pressure parameters as closely correlated to the final claudication distance, but not to the actions indicated above. At the second stage, 62 persons showed both the initial and final claudication distances as dependent on the poststenotic pressure as well as on the pressure gradient. Stepwise regression analysis showed a significant dependence of both distances on the lowest pressure measured on four crural arteries. The closest correlation [R = 0.98] was found between the initial and final claudication distances which persisted even after elimination of all pressure parameters.

Adult↗
PubMed1989

Effects of exercise training on common femoral artery blood flow in patients with intermittent claudication.

Exercise training is a commonly used rehabilitative therapy for patients with intermittent claudication (IC). However, it is not known whether blood flow through the major conduit vessel of the leg, the common femoral artery (CFA), increases with exercise training. We tested the hypothesis that peak CFA blood flow will increase with a supervised, lengthy, and individualized exercise training program. Subjects were 10 IC patients (eight men, two women) with a mean age of 61 +/- 7 (mean +/- SD) years who had either aortoiliac (n = 7) or femoropopliteal (n = 3) stenosis. Using noninvasive Doppler flowmetry, we measured CFA blood flow and ankle pressure at rest and after a maximum symptom-limited graded treadmill test before (T1) and after 3 (T2) and 5 (T3) months of exercise training. Variables were measured in the supine and upright postures at rest and during recovery. Total walking distance and claudication distance on the treadmill were determined for T1, T2, and T3. After training, CFA blood flow and ankle pressure were not significantly higher at rest or at 1 minute after exercise compared with pretraining despite significant increases in claudication and total walking distances. The rate of CFA blood flow recovery was slower at T3, suggesting the accrual of a larger metabolic debt during exercise due to more work performed. We conclude that changes in CFA blood flow are not responsible for measured changes in performance with exercise training in IC patients.

Blood Flow Velocity↗
PubMed1989

[Intermittent claudication of the jaw in temporal arteritis].

Stiffness of the jaw was noted in the first descriptions of temporal arteritis. It was only in 1944 that Horton used the term intermittent claudication and related this sign to effort ischemia due to thrombosis of facial arteries. The introduction of ultrasound techniques has enabled the permeability of facial arteries to be confirmed in spite of induration and absence of pulsatility clinically. Anatomical studies have defined the preponderant role of the internal maxillary artery in the vascular supply of the masseter muscles and have enabled the localization of an appropriate and reliable site for ultrasound study: the pterygo-maxillary fossa. The velocimetric data thus collected confirm that the internal maxillary artery is affected and define the etiopathogenesis of intermittent jaw claudication during temporal arteritis. This sign is observed on average in one patient in three suffering from temporal arteritis. While several cases of intermittent jaw claudication have been described in severe atheromatous stenosis of the common carotid or external carotid arteries, or in relation to other causes (rheumatological, neoplastic, psychological ...), the observation of this syndrome in a suspicious clinical and paraclinical context constitutes an excellent orientation sign in favor of temporal arteritis.

Giant Cell Arteritis↗
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↗
PubMed1989

Changes of walking distance in patients with intermittent claudication during six months intensive physical training.

Patients with intermittent claudication were treated with six months intensive physical training. They were instructed to walk with a speed of 6 km/h until they got complaints and then to rest for some time. This sequence was repeated until men below 65 years had walked 2 km. Men above the age of 65 years and women had to walk 1.5 km. This training session was performed 3 times a day. Every two months the claudication distances in a corridor and on a treadmill were measured. Out of 95 patients 65 completed the training. In 38 patients (59%) there was no substantial change in walking distance. Fourteen patients (22%) doubled their walking distance, seven (11%) could walk more than 1000 m, but their complaints remained. Six (9%) could walk more than 1000 m without claudication pain. Most patients gained their result during the last 2 months of the program. After the training 48% of the patients were satisfied with their walking distance.

Adult↗
PubMed1988

Unilateral intermittent claudication of the left lower extremity.

Numerous approaches including surgery for the release of cauda equina compression symptoms due to vertebral canal stenosis are well known. The successful use of spinal manipulative therapy for reduction of neurogenic claudication symptoms is discussed in this case presentation. An elderly male presents with vague leg pain and paresthesias of the left lower extremity precipitated by walking. A brief discussion of the etiology, symptomatology and diagnosis of claudication is made. Methods of differential diagnosis of vascular vs. neurogenic claudication are discussed.

Aged↗
PubMed1987

[Intermittent venous claudication: a rarely diagnosed walking disability].

Intermittent venous claudication occurs mostly in young, physically active people after iliac vein thrombosis. In 20 healthy volunteers and 4 patients with venous claudication, plethysmographic volume measurements of the thigh and calf were made during treadmill work (10 degrees gradient, 7 km/h). The mean volume of the calf in the 20 healthy controls decreased at the beginning of exercise, climbed again later and reached a plateau after 100 sec, indicating a balance between arterial inflow and venous drainage. In the 4 patients with status after iliac vein thrombosis the volume of the affected leg rose continuously during exercise without reaching a plateau, until leg pain forced the patient to stop. The measured volume of the affected leg at the point of pain was higher than that of the patients' contralateral leg and higher than that of the controls (p less than 0.01). Strain-gauge plethysmography during treadmill work permits non-invasive, objective diagnosis of the venous drainage abnormality that leads to intermittent venous claudication.

Adult↗
PubMedDate not supplied

Venous claudication. A report of 15 cases and a review of the literature.

The symptom of intermittent claudication is not invariably due to arterial disease. Exercise-related pain resulting from venous insufficiency is poorly defined, but has been described by a number of authors in the past. Fifteen patients with symptoms suggestive of venous claudication are reported. The history and clinical findings are described. The further investigation of these patients is outlined, starting with the non-invasive methods of Doppler ultrasonography and strain gauge plethysmography. Ascending phlebography was performed on all affected limbs (n. 19) and descending phlebography was performed on those shown to have a patent deep venous system. These investigations demonstrated deep venous abnormalities associated with the distinct symptom complex. Venous claudication is defined and the literature reviewed. It is hoped that a clearer understanding of the condition will result in more frequent and accurate diagnosis with subsequent benefit to the patient.

Adult↗
PubMed1979

The management of intermittent claudication.

Many patients with intermittent claudication improve due to development of collateral vessels. Only a small proportion worsen, and few progress to severe ischaemia with the risk of amputation. Accordingly, most patients can be reassured and treated expectantly. Those patients have a reduced life expectancy compared with the population at large. Thus, surgical treatment should be reserved for patients who are severely restricted by claudication. The early technical results of arterial reconstruction for claudication are excellent. However, the late results are much worse in patients who continue to smoke. Nowadays, the complication rate from surgery is low.

Adult↗
PubMed1983

Peripheral vasodilators versus pentoxifylline for the treatment of intermittent claudication.

It should be recalled that the seven-center study conducted in the United States was initiated at a time when American physicians had recognized that past attempts to prove efficacy of peripheral vasodilators in treadmill testing had failed. The positive results derived from pentoxifylline treatment are significant because, for the first time, treadmill testing can prove the effectiveness of a hemorheologic drug, such as pentoxifylline, in the treatment of patients with intermittent claudication. Since treadmill testing is regarded as the most objective measurement of therapeutic success in claudicant patients, the positive results can assure us that hemorheologic drugs increasing erythrocyte flexibility are highly desired in treating peripheral vascular insufficiency, such as intermittent claudication.

Absorption↗
PubMed1978

Cardiac arrhythmias associated with treadmill claudication testing.

Eighty-one consecutive patients of an average age of 58 years with suspected lower limb arterial disease underwent standard 5-minute treadmill claudication testing. Prior to, during, and after testing the patients were monitored electrocardiographically. The number of electrocardiographic abnormalities seen in 81 patients undergoing study increased from 33 (40.6%) at rest to 49 (60.5%) with exercise. The commonest abnormalities encountered with exercise were the development and increased incidence of paroxysmal beats and ST-T wave changes which, in some instances, became life-threatening, aborting the test. Since the principal hazard for patients with claudication appears to derive from an increase propensity to cardiac mortality and morbidity, rather than from the consequences of impaired circulation to the limb, electrocardiographic monitoring during treadmill claudication testing, though little practiced, is strongly advised.

Adolescent↗
PubMed1984

Arteriographic findings of claudication patients.

The purpose of this work was to study what kind of types of arteriographic changes occur in patients with claudication, whether the patients can be divided into different groups on the basis of the morphology of the arteriographic findings, whether there are any correlations between the arteriographic findings and the patient's age, sex, occupation, bodyweight, smoking habits, diabetes, hypertonia and the arteriosclerosis of the cerebral and coronary arteries. The series consisted of 490 patients subjected to arteriography of the lower extremities because of claudication. There were 399 males and 91 females. The following changes were seen in the arteries of claudication patients: --tortuosity of the distal aorta and the iliac arteries --arteriosclerotic wall changes varying from intimal thickenings to complete occlusions --collaterals --calcific deposits on vascular walls --aneurysms of the distal aorta. The vessels located proximally to the inguinal ligament were tortuous in 63,1% of the patients and extremely tortuous in 11,2%. Single wall changes were seen rarely; 69% of the patients had more than 6 separate plaques. Smooth and flat plaques were also few. 78% of the patients had wall changes of mixed shapes, and 81% had wall changes with irregular contour. A complete occlusion of a vessel was detected in 67%. Symmetric ASO changes were seen in the extremities of 5,3% of the patients. On the basis of the location and extent of the arteriographically diagnosed wall changes, the series was divided into three main groups. The first main group was further divided into three subgroups and the latter two into two subgroups each. Slightly more than half of the patients belonged to the largest group I A, where arteriosclerotic changes were detected in all segments. Gangrenous changes were most frequent in this group. The patients in group III A, which consisted of diffuse changes of the femoro-popliteal region, had the highest (31,8%) frequency of concomitant diabetes and the second highest (30,3%) frequency of concomitant hypertonia. Hypertension was most frequent as a concomitant disease (42,9%) in group I B, which consisted of the patients with aneurysms of the distal aorta. Single arteriosclerotic changes in the femoropopliteal region were few (1,2%). Vascular tortuosity increased with age. The older age groups had more arteriosclerotic changes particularly in the distal aorta, the deep femoral artery, the superficial femoral artery and the popliteal artery.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗