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PubMed1998

Percutaneous transluminal angioplasty for intermittent claudication: evidence on which to base the medicine.

OBJECTIVES: This study aims to assess the impact of PTA on the quality of life (QoL) of claudicants and to analyse which patients and which arterial lesions derive the most benefit. DESIGN: A prospective observational study. MATERIALS: One hundred and seventeen claudicants undergoing PTA were studied; 35 patients had bilateral disease, whilst 82 had unilateral disease and underwent PTA to a solitary iliac lesion, solitary superficial femoral or a iliac lesion above a diseased superficial femoral artery in 24, 39 and 19 cases, respectively. METHODS: Patients completed the Short Form 36 (SF36) and EuroQol (EQ) QoL assessment instruments prior to and at 1, 3, 6, and 12 months following intervention. The SF36 produces a QoL profile, whilst the EQ produces two QoL indices. RESULTS: Claudication has a deleterious effect on QoL, especially in patients with multi-segment disease. PTA results in an immediate and lasting improvement in the QoL of claudicants. Unilateral claudicants undergoing PTA to a solitary iliac lesion demonstrate the most marked QoL benefits and 12 months post PTA report a QoL approaching that of an age-matched population. Patients with bilateral claudication undergoing unilateral PTA and unilateral claudicants undergoing PTA to a solitary SFA lesion demonstrate some QoL benefits, but at 12 months post PTA do not approach the QoL scores of an age-matched population. Unilateral claudicants undergoing iliac PTA above a diseased SFA demonstrate minimal QoL changes. CONCLUSIONS: These results should influence decision making in the management of claudication and it may be possible to prioritise PTA waiting lists to ensure patients with greatest potential benefit are treated with most urgency.

Adult↗
PubMed2002

The severity of muscle ischemia during intermittent claudication.

PURPOSE: The degree of ischemia during intermittent claudication is difficult to quantify. We evaluated calf muscle ischemia during exercise in patients with claudication with near infrared spectroscopy. METHODS: A Critikon Cerebral Redox Model 2001 (Johnson & Johnson Medical, Newport, Gwent, United Kingdom) was used to measure calf muscle deoxygenated hemoglobin (HHb), oxygenated hemoglobin (O(2)Hb), and total hemoglobin levels and oxygenation index (HbD; HbD = O(2)Hb - HHb) in 16 patients with claudication and in 14 control subjects before, during, and after walking on a treadmill for 1 minute (submaximal exercise). These measures were repeated after a second maximal exercise in patients with claudication and after 7 minutes walking in control subjects. Near-infrared spectroscopy readings during maximal exercise were then compared with a model of total ischemia induced with tourniquet in 16 young control subjects. RESULTS: Total hemoglobin level changed little during exercise in both patients with claudication and control subjects. HHb levels rose, and O(2)Hb level and HbD falls were more pronounced in patients with claudication than in control subjects after submaximal and maximal exercise. During maximal exercise, HbD fell markedly by a median (interquartile range) of 210.5 micromol/cm (108.2 to 337.0 micromol/cm) in patients with claudication compared with 66.0 micromol/cm (44.0 to 101.0 micromol/cm) in elderly control subjects and 41.0 micromol/cm (36.0 to 65.0 micromol/cm) in young control subjects (P <.001). This fall also was greater than the HbD fall induced with tourniquet ischemia at 90.8 micromol/cm (57.6 to 126.2 micromol/cm; P =.006). CONCLUSION: Hemoglobin desaturation in exercising calf muscle is profound in patients with claudication, considerably greater even than that induced with three minutes of tourniquet occlusion. Further studies are necessary to investigate the relationship between the inflammatory response and near-infrared spectroscopy during exercise in patients with claudication.

Adult↗
PubMed1996

Spinal intermittent claudication due to cervical and thoracic degenerative spine disease.

STUDY DESIGN: Neurogenic intermittent claudication can be caused by spinal cord compression. In this study, 20 patients with spinal intermittent claudication due to degenerative spine diseases were evaluated. OBJECTIVES: This study clarified the clinical features and pathomechanism of spinal intermittent claudication due to degenerative spine diseases. SUMMARY OF BACKGROUND DATA: Spinal intermittent claudication may either be produced by intrinsic or extrinsic lesions. Little is known about spinal intermittent claudication due to extrinsic lesions such as spinal cord compression. Twenty patients with spinal intermittent claudication, caused by cervical or thoracic lesions, who were given surgical treatment except for one, were studied. Their main subjective symptoms were tightness, weakness, and numbness in the lower limbs and a strangulated sensation in the trunk to lower limbs. The objective findings were occurrence and/or aggravation of spinothalamic signs. METHODS: The gait loading test was performed on these 20 patients. Selective spinal angiography was performed on the patients with thoracic myelopathy and its therapeutic effects were evaluated. A radiographic assessment was made in all patients. RESULTS: The subjective symptoms and objective findings were reproduced by the gait loading test. Selective spinal angiography temporarily relieved or improved the spinal intermittent claudication due to the thoracic myelopathy. Spinal intermittent claudication disappeared immediately after surgical treatment. CONCLUSIONS: Circulatory impairment of the spinal cord seems to be closely related to the etiology of spinal intermittent claudication. Besides providing diagnostic information, selective spinal angiography may also have a temporary therapeutic effect.

Adult↗
PubMed2001

A long-term study of policosanol in the treatment of intermittent claudication.

Policosanol is a cholesterol-lowering drug with concomitant antiplatelet effects. This study was undertaken to investigate the long-term effects of policosanol administered to patients with moderately severe intermittent claudication. The study consisted of a 6-week single-blind, placebo-controlled run in phase, followed by a 2-year double-blind, randomized treatment step. Fifty-six patients who met study entry criteria were randomized to receive placebo or policosanol 10 mg twice daily. Walking distances on a treadmill (constant speed 3.2 km/h, slope 10 degrees, temperature 25 degrees C) were assessed before and after 6, 12, 18, and 24 months of treatment. Both groups were similar at randomization. After 6 months of therapy, policosanol significantly increased (p < 0.01) the initial claudication distance from 125.9 +/- 8.7 m to 201.1 +/- 24.8 m and the absolute claudication distance from 219.5 +/- 14.1 m to 380.7 +/- 50.2 m. Both variables remained unchanged in the placebo group (p < 0.01). These effects did not wear off but improved after long-term therapy, so that final values were 333.5 +/- 28.6 m (initial claudication distance) and 648.9 +/- 54.1 m (absolute claudication distance); both significantly greater (p < 0.0001) than those obtained in the placebo group, which showed values of 137.9 +/- 21.8 m (initial claudication distance) and 237.7 +/- 28.1 m (absolute claudication distance), respectively. At study completion, 21 policosanol and 5 placebo patients attained increases in claudication distance values > 50% (p < 0.001). Policosanol, but not placebo, significantly increased the ankle/arm pressure index. In addition, from month 6 up to study completion, the frequency of patients reporting improvement of lower limb symptoms was greater in the policosanol group than in the placebo group. The treatment was tolerated well. There were 16 withdrawals (12 placebo, 4 policosanol) from the study. Eight patients in the placebo group experienced a total of 10 serious adverse events, 8 of which were vascular events, compared with none in the policosanol group (p < 0.01). In addition, 3 patients in the policosanol group and 3 patients in the placebo group reported mild adverse events during the study. The present results demonstrate the long-term usefulness of policosanol therapy to treat patients with intermittent claudication.

Adult↗
PubMed1999

The natural history of claudication: risk to life and limb.

Although a patient with intermittent claudication (IC) will fear progression to severe disease and amputation, this is a relatively rare outcome of claudication, with only 1% to 3% of claudicants ever requiring major amputation over a 5-year period. Indeed, in one study, 50% of claudicants became symptom free during 5 years' follow-up. All the new evidence over the last 40 years has not altered the impression that only about one fourth of patients with IC will ever significantly deteriorate, and that deterioration is most frequent during the first year after diagnosis (6 to 9%) compared with 2% to 3% per annum thereafter. Smoking is the most important risk factor for the progression of local disease in the legs, with an amputation rate 11 times greater in smokers than nonsmokers. Diabetes, male gender, and hypertension are also important risk factors for progression. Because cerebrovascular disease (CVD), coronary artery disease (CAD), and peripheral arterial occlusive disease (PAOD) coexist, PAOD and IC should be regarded as a marker for increased risk from fatal and nonfatal cardiovascular event, and 2% to 4% of claudicants have a nonfatal cardiovascular event every year. The risk is higher in the first year after developing IC than in a long-standing stable claudicant, and the average claudicant is more likely to have a nonfatal myocardial infarction (MI) or stroke in the next year that of ever requiring a major amputation for his leg ischemia. The mortality in claudicants is 30% at 5 years, 50% at 10 years, and 70% at 15 years, without any clear decrease in these figures over the last 30 to 40 years. The mortality of claudicants is approximately two and a half times that of an age-matched general population.

Adult↗
PubMed2001

Claudication does not always precede critical leg ischemia.

Prevalence of intermittent claudication is often used to calculate the prevalence of critical leg ischemia (CLI), a more severe form of peripheral arterial disease (PAD). Although this logical course of the disease is intellectually appealing, not all patients with CLI have experienced any symptoms of previous claudication. A total of 100 consecutive patients with objective evidence of critical ischemia, as evaluated by non-invasive testing in the authors' vascular laboratory, were subjected to a structured interview to evaluate how often peripheral arterial disease is presented with symptoms of CLI as the initial complaint. In all, 37 patients had never experienced claudication prior to the development of CLI. Furthermore, 12 of 63 patients who suffered from previous claudication did not have any claudication symptoms at the time of the development of CLI. Of the 37 patients with CLI as the first sign of PAD, 20 had diabetes--four of whom with manifest diagnosed neuropathy. The patients without previous claudication more frequently had ulcers as the initial symptom of CLI (89%) than those with claudication (59%), whose disease first progressed to rest pain. Altogether, 25 patients did not walk enough to develop symptoms of claudication. In conclusion, every patient presenting with symptoms potentially related to CLI should undergo vascular laboratory measurements regardless of whether he/she has a history of claudication or not. This is especially true in limbs with unhealed skin lesions.

Adult↗
PubMed2003

Beneficial effects of exercise beyond the pain threshold in intermittent claudication.

BACKGROUND: The quality of life and autonomy may be severely hampered in patients with intermittent claudication, but the amputation rate is very low. Supervised exercise training is effective, but still very rarely employed. Many authors think that in these patients exercise over the pain threshold may be dangerous. The aim of this study was to assess whether supervised, 3-month duration, 3 times/week, beyond the pain threshold exercise training is safe and whether it improves both the performance and quality of life in patients with claudication. METHODS: Forty-three patients with claudication, confirmed at Doppler study and/or angiography, have been evaluated by means of graded treadmill testing, the ankle-brachial pressure index at rest and after walking and a Walking Impairment Questionnaire before and after 3 months of treadmill training beyond the claudication threshold. RESULTS: Patients showed an 86% increase in time to onset of claudication pain (p < 0.00001), a 50% increase in total walking time (p < 0.000001) and improved questionnaire scores of pain intensity (%, p < 0.005), distance covered (+87%, p < 0.005), speed (+42%, p < 0.05), and stair climbing (+25%, p = NS). The basal and post-exercise ankle-brachial pressure index was not modified by training. Analysis of all subgroups of patients (</> 65 years of age, with/without coronary artery disease and diabetes mellitus, pre-training time to onset of claudication pain </> 3 min, with angiographic/Doppler occlusion or stenosis) revealed a statistically significant increase in both time to onset of claudication pain and total walking time. CONCLUSIONS: Supervised physical training beyond the claudication threshold significantly improves the walking time and quality of life of patients with claudication.

Arterial Occlusive Diseases↗
PubMed1985

Beta blockade and intermittent claudication.

The aim of the present study was to evaluate whether beta blockade presents a risk of intermittent claudication and how it affects the walking capacity and lower limb haemodynamics in patients with intermittent claudication. The study was divided into six parts: A case-control study with 55 pairs, cases with hypertension and intermittent claudication and controls with hypertension only, matched for age, sex, place of residence, and time of examination, all without coronary heart disease, which is a known confounding factor. An open controlled study on the effect of withdrawal of beta blockade on walking capacity of 28 patients with intermittent claudication. A placebo-controlled double-blind crossover study on the effect of antihypertensive treatment on the walking capacity of 14 patients with intermittent claudication. Three placebo-controlled double-blind crossover studies on the effect of propranolol, metoprolol, pindolol, labetalol, and/or methyldopa on calf blood flow in 34 hypertensive subjects without peripheral arterial disease and in altogether 21 patients with intermittent claudication. Walking capacity was measured on a treadmill. Calf blood flow was measured with strain gauge plethysmography by the venous occlusion technique. The case-control comparison showed that beta blockers were used as often by patients with intermittent claudication as by controls. Walking capacity increased during the first month of the open controlled study irrespective of whether the beta blockade was withdrawn or continued. There was no difference in this respect between the various types of beta blockers. Antihypertensive treatment with metoprolol or methyldopa did not affect walking capacity. Resting calf blood flow was unaffected by propranolol or metoprolol, regardless of the presence or absence of peripheral arterial disease, as well as by pindolol, labetalol, or methyldopa in patients with intermittent claudication. During reactive hyperaemia, propranolol and metoprolol reduced flow in patients without peripheral arterial disease. Propranolol also reduced hyperaemic blood flow in the limb with less or no symptoms in patients with intermittent claudication. None of the active drugs decreased the hyperaemic flow consistently in the limb with the stronger symptoms. In a comparison of haemodynamic effects between the drugs, calf blood flow at rest was higher after pindolol than after propranolol and hyperaemic flow of the better limb was higher after pindolol than after propranolol and labetalol.(ABSTRACT TRUNCATED AT 400 WORDS)

Adrenergic beta-Antagonists↗
PubMed2005

Effects of warm-up on exercise capacity, platelet activation and platelet-leucocyte aggregation in patients with claudication.

BACKGROUND: The effects of exercise and warm-up were investigated in patients with claudication. METHODS: This case-control crossover study involved two treadmill exercise tests, one preceded by a warm-up. Exercise continued until maximal leg pain (patients with claudication) or exhaustion (controls). Blood was taken before, and 5 and 60 min after exercise for flow cytometric analysis of platelet activation and platelet-leucocyte aggregation. RESULTS: Both cohorts (eight patients with claudication of median age 63 years and eight healthy controls of median age 63.5 years) demonstrated improvement in exercise capacity after warm-up (13.1 per cent, P = 0.012 and 15.6 per cent, P = 0.008 respectively). Platelet activation increased after exercise in patients with claudication (fibrinogen binding: 1.11 per cent before exercise versus 2.63 per cent after exercise, P = 0.008; P-selectin: 0.68 versus 1.11 per cent, P = 0.028). Neither agonist stimulation nor warm-up altered this trend. Platelet-leucocyte (PLA) and platelet-neutrophil (PNA) aggregation were similarly increased immediately after exercise in patients with claudication (PLA: 7.6 versus 13.0 per cent, P = 0.004; PNA: 6.8 versus 10.2 per cent, P = 0.012). These remained high 60 min after exercise only in patients with claudication, but recovered to baseline levels when preceded by warm-up. Warm-up significantly desensitized PNA after stimulation with 10 micromol/l adenosine 5'-diphosphate at all time points. CONCLUSION: Warm-up increased the exercise capacity of patients with claudication. Exercise induced a thromboinflammatory response, with PLA and PNA persistently increased after 60 min in patients with claudication, an effect diminished after warm-up.

Adenosine Diphosphate↗
PubMed2005

Improvement of the walking ability in intermittent claudication due to superficial femoral artery occlusion with supervised exercise and pneumatic foot and calf compression: a randomised controlled trial.

OBJECTIVES: To compare the effect of unsupervised exercise, supervised exercise and intermittent pneumatic foot and calf compression (IPC) on the claudication distance, lower limb arterial haemodynamics and quality of life of patients with intermittent claudication. METHODS: Thirty-four eligible patients with stable intermittent claudication were randomised to IPC (n = 13, 3h/d for 6 months), supervised exercise (n = 12, three hourly sessions/week for 6 months) or unsupervised exercise (n = 9). In each patient, initial claudication distance (ICD), absolute claudication distance (ACD), resting ankle brachial pressure index (ABPI), and resting hyperaemic calf arterial inflow were measured before, 6 weeks, 6 months and 1 year after randomisation. Quality of life was assessed with the short form (SF)-36, walking impairment (WIQ) and intermittent claudication questionnaires (ICQ). RESULTS: Compared with unsupervised exercise, both IPC and supervised exercise, increased ICD and ACD, up to 2.83 times. IPC increased arterial inflow (p < 0.05 at 6 weeks) and ABPI. Supervised exercise decreased arterial inflow and increased ABPI (p < 0.05 at 6 months). Unsupervised exercise had no effect on arterial inflow or ABPI. IPC improved significantly the ICQ score and the speed score of the WIQ, while supervised exercise improved the WIQ claudication severity score. At 1 year clinical effectiveness of supervised exercise and IPC was largely preserved. CONCLUSIONS: IPC, by augmenting leg perfusion, achieved improvement in walking distance comparable with supervised exercise. Long-term results in a larger number of patients will provide valuable information on the optimal treatment modality of intermittent claudication.

Aged↗
PubMed1995

Lipoprotein(a) distribution in a French Canadian population and its relation to intermittent claudication (the Québec Cardiovascular Study)

This study was undertaken to evaluate the distribution and the relation of lipoprotein(a) (Lp[a]) concentration with intermittent claudication in a cohort of men aged 35 to 64 years, randomly selected in 1974 and followed until 1990. In 1985, blood samples for a complete fasting lipid profile and Lp(a) were obtained in 2,424 men representing 62% of the living cohort. The diagnosis of intermittent claudication was made by trained nurses using a standardized questionnaire and confirmed by a cardiologist. Lp(a) distribution did not change with age and was similar to that of other Caucasian populations. Because Lp(a) concentration did not vary with age, its relation to the incidence of intermittent claudication was assessed for the years 1974 to 1990. The incidence of intermittent claudication was 42 of 10,000 person-years. The 113 men with intermittent claudication, in contrast to men without this symptomatology, were older at entry (49 +/- 7 vs 45 +/- 7 years), and had higher systolic pressure (144 +/- 20 vs 136 +/- 16 mmHg) and Lp(a) levels (46 +/- 45 vs 33 +/- 35 mg/dl) (all p < 0.05). There was also a significantly greater prevalence of smoking and diabetes among men with intermittent claudication. The risk of intermittent claudication was doubled in men in the second and third tertiles of Lp(a) concentration (p < 0.001). Thus, high Lp(a) levels constitute a significant risk for intermittent claudication in this population.

Adult↗
PubMed2005

Measuring the rate of change of haemodynamic response at the onset of exercise in normal limbs and those with intermittent claudication.

Patients with claudication have an inadequate haemodynamic response to exercise. Blood flow response will not only have a magnitude, but also a rate of change. There is scope for investigating these parameters, as manipulation of the factors which control them may benefit work to improve the treatment for claudication. This work compares the responses for patients with one normal limb and one with intermittent claudication. A custom-built ergometer allows unilateral, infragenicular plantar flexion exercise, whilst common femoral artery blood flow can be measured continuously by Duplex ultrasound. This apparatus was used to measure blood flow before, at the onset of and during a 5 W square-wave exercise stimulus in 15 patients. The claudicant group had a mean steady-state gain that was approximately half that of the normal group at around 170 ml min(-1) (p < 0.001) and a response time that was much shorter (p = 0.006). A mean response time of 21.0 +/- 1.4 s was achieved in claudicant limbs compared to 31.8 +/- 2.9 s in normals. However, the average rate of change of blood flow during this response time was estimated to still be greater for the normal group, at 431.7 +/- 47.1 ml min(-2), than for the claudicant group. The differences in magnitude and rate of change of limb blood flow response to exercise in claudicants were significant and may have implications for the treatment of claudication.

Adaptation, Physiological↗
PubMed2000

Prospective study of diet, lifestyle, and intermittent claudication in male smokers.

The association between dietary and lifestyle factors and intermittent claudication was investigated in the Finnish Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. The cohort comprised 26,872 male smokers aged 50-69 years who were free of claudication at study entry. At baseline (1985-1988), subjects completed a diet history questionnaire. During a median follow-up period of 4 years (ending in spring 1993), 2,578 men reported symptoms of claudication on the Rose questionnaire, which was administered annually. Smoking status was assessed every 4 months. Smoking, systolic blood pressure, serum total cholesterol, and diabetes mellitus were positively associated with risk for claudication, whereas serum high density lipoprotein cholesterol, education, and leisure time exercise were inversely associated with risk. Dietary carbohydrates, fiber, and n-6 polyunsaturated fatty acids were inversely associated with risk for claudication, as were some dietary and serum antioxidants: dietary vitamin C (highest quartile vs. lowest: relative risk (RR) = 0.86; 95% confidence interval (CI): 0.77, 0.97), dietary gamma-tocopherol (RR = 0.89; 95% CI: 0.79, 1.00), dietary carotenoids (RR = 0.82; 95% CI: 0.73, 0.92), serum alpha-tocopherol (RR = 0.88; 95% CI: 0.77, 1.00), and serum beta-carotene (RR = 0.77; 95% CI: 0.68, 0.86). Smoking cessation reduced subsequent risk for claudication (RR = 0.86; 95% CI: 0.75, 0.99). The authors conclude that classical risk factors for atherosclerosis are associated with claudication. High intakes of antioxidant vitamins may be protective. Further research is needed before antioxidants can be recommended for the prevention of intermittent claudication.

Administration, Oral↗
PubMed2002

Sex differences in claudication pain in subjects with peripheral arterial disease.

PURPOSES: To compare the claudication distances between men and women patients with peripheral arterial disease (PAD), and to determine whether sex differences in claudication pain persisted after controlling for potential confounders such as demographic, functional, and physiological measures. METHODS: A total of 488 men and 72 women functionally limited by intermittent claudication were evaluated. Patients were characterized on PAD-specific measures consisting of ankle/brachial index (ABI) and treadmill claudication distances, physical function measures consisting of ambulatory function, monitored physical activity, balance, and strength, and demographic measures obtained during a medical history. RESULTS: Initial claudication distance (ICD) was 33% shorter ( = 0.024) in women than in men (126 +/- 22 vs 189 +/- 13 m; mean +/- SEM), and absolute claudication distance (ACD) was 23% shorter ( = 0.022) in women (313 +/- 43 vs 407 +/- 18 m). These differences were present despite similar ( = 0.440) ABI values between women (0.63 +/- 0.02) and men (0.62 +/- 0.01). Peak oxygen uptake ( = 0.043) and self-perceived stair climbing ability ( = 0.020) were different between men and women, and were independently related to ICD (multiple R = 0.57, < 0.001) and to ACD (multiple R = 0.71, < 0.001). The sex differences in ICD ( = 0.524) and ACD ( = 0.722) were no longer present after controlling for peak oxygen uptake and self-perceived stair climbing ability. CONCLUSION: Shorter treadmill claudication distances in women with PAD were explained by their lower cardiopulmonary fitness and poorer self-perceived ability to climb stairs than compared with men. Therefore, women with intermittent claudication represent a subgroup of PAD patients who should receive high priority for exercise rehabilitation to improve physical function.

Age Distribution↗
PubMed1982

Prevalence of intermittent claudication and its effect on mortality.

The prevalence of symptoms of intermittent claudication and their association with 5-year mortality were examined in a population study in Finland. A number of 5738 men and 5224 women, aged 30-59 years, from 4 geographic areas of the country were studied. According to a structured interview, 2.1% of the men and 1.8% of the women reported typical symptoms of intermittent claudication. Claudication was most prevalent in East Finland and among persons with agricultural occupations. The symptoms were more frequent in diabetics and persons with symptoms and signs of coronary heart disease (CHD) than in persons without these diseases. High serum cholesterol and smoking were associated with these symptoms but high blood pressure was not. The risk of death from cardiovascular causes was nearly 3-fold in men with claudication compared to men without claudication. Symptoms of chest pain and smoking increased significantly the mortality risk of male claudicants. The validity of symptoms was poorer in women than in men and they were also less reliable predictors of death in women. A small part of the effect of claudication on mortality was due to its association with conventional CHD risk factors. However, after adjusting for symptoms and signs of CHD, claudication had no independent effect on mortality in men.

Adult↗
PubMed1997

Current and future drug therapies for claudication.

The primary objectives of claudication treatment are to reduce cardiovascular mortality and improve walking ability. Patients with claudication have 60% mortality over 10 years, with most deaths due to myocardial infarction and stroke. Aggressive risk-factor modification is required in all these patients, particularly smoking cessation, lipid modification, and treatment of hypertension, diabetes and elevated homocysteine levels. Aspirin, ticlopidine and clopidogrel are all effective in reducing the risk of myocardial infarction, stroke and vascular death, and thus antiplatelet therapy should be considered in all claudicants. Patients with disabling claudication should be considered for therapies that relieve claudication pain and improve exercise performance, the most effective being exercise training and smoking cessation. Pentoxifylline, the only approved claudication drug in the United States, has modest efficacy in improving treadmill exercise performance. Other drugs shown to be of some benefit in patients with claudication include propionyl-L-carnitine, cilostazol and possibly prostaglandin derivatives. Several antiplatelet agents and angiogenic growth factors are also being evaluated for the treatment of claudication.

Enzyme Inhibitors↗
PubMed2004

Ischemic stroke in patients with intermittent claudication: a clinical study of 142 cases.

The clinical features, risk factors, neuroimaging findings, and outcome of acute ischemic stroke were assessed in patients with intermittent claudication. Data from 142 patients with ischemic stroke and intermittent claudication were collected from a prospective hospital-based stroke registry in which 2500 consecutive acute stroke patients attended over a 12-year period. Ischemic stroke in patients with intermittent claudication accounted for 7.7% of all ischemic strokes (n = 1840). Ischemic stroke with and without intermittent claudication showed a similar in-hospital mortality rate (16% vs 14%) and absence of functional limitation at hospital discharge (20.5% vs 18.5%). Ischemic stroke patients with intermittent claudication showed a significantly shorter length of stay than patients without symptomatic peripheral arterial disease (14.6 vs 18.8 days, p < 0.05). Ischemic heart disease, transient ischemic attack (TIA), renal dysfunction, and watershed infarct were significant independent predictors of ischemic stroke in patients with intermittent claudication. Although cerebral infarction in patients with intermittent claudication showed a clinical profile suggestive of poor outcome, the prognosis was similar to that of ischemic stroke without intermittent claudication.

Aged↗
PubMed2001

New treatment options in intermittent claudication: the US experience.

The goals of treatment in intermittent claudication are to modify cardiovascular risk factors and to reduce claudication pain, increase walking distance and improve quality of life. Walking distance in intermittent claudication can be improved both by exercise rehabilitation and by pharmacological treatments. At present, the only two drugs licensed in the US for the treatment of claudication symptoms are oxpentifylline and cilostazol. Although oxpentifylline has been shown to increase maximal and pain-free walking distance in a number of trials, other studies call its efficacy into question. Eight double-blind, placebo-controlled trials have established that cilostazol improves both maximal and pain-free walking distance in patients with moderate to severe intermittent claudication, with highly statistically significant differences compared with placebo. Cilostazol has also been shown to improve the physical dimensions of quality of life. Naftidrofuryl is licensed for the treatment of intermittent claudication in Europe, but not in the US. Some clinical trials have shown it to be effective in treating intermittent claudication. Promising new agents in the treatment of intermittent claudication include L-arginine, propionyl-L-carnitine, prostaglandins, and angiogenic growth factors such as vascular endothelial growth factor and basic fibroblast growth factor.

Arginine↗