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Results for “INTERMITTENT CLAUDICATION”

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PubMed1984

Placebo-controlled double-blind trial of ketanserin in treatment of intermittent claudication.

Ketanserin, a selective serotonin (5-HT) antagonist at 5-HT2 receptors, was investigated in a 3-month, double-blind, placebo-controlled study in twenty patients with intermittent claudication. Blood-pressure ratio (thigh/arm), reactive hyperaemia measured with an ECG-triggered venous occlusion plethysmograph, blood filterability, and claudication distance on a treadmill progressively and significantly improved during ketanserin therapy, whereas no such changes occurred in the placebo group. Mean claudication distance improved by 140%; four of the eleven patients on ketanserin were able to keep walking beyond the time limit of the exercise test. The beneficial effect of ketanserin suggests that 5-HT may be involved in the pathogenesis of peripheral arterial obstructive diseases. In an experiment comparing blood-pressure ratio measured by doppler velocimetry and by plethysmography, the plethysmographic values rose during ketanserin therapy only at thigh level, which suggests an improvement in the collateral circulation.

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PubMed1989

[Intermittent claudication and risk factors among men 40 to 59 years of age based on the data of a prospective population study].

A study was made of the prevalence of intermittent claudication (IC) and risk factors among men aged 40 to 59 years and of the acute myocardial infarction lethality and incidence during ten years of the follow up. Using standard techniques a representative group of 6117 men were examined. The prevalence of IC amounted to 0.89% in the group under study (standardized according to age). Analysis of the relationship between the prevalence of IC and risk factors has demonstrated the presence of the significant correlation only among men with hypercholesterolemia and tobacco smokers. In men who suffered myocardial infarction, the rate of IC was higher than in men with angina pectoris of effort, painless coronary disease or without coronary disease. Analysis of the acute myocardial infarction lethality and incidence has shown that they are significantly higher among men with IC than in those without this pathology.

Adult↗
PubMed1996

Changes in energy metabolism of calf muscle in patients with intermittent claudication assessed by 31P magnetic resonance spectroscopy: a phase II open study.

Energy status and metabolism in skeletal muscle of nine patients with peripheral arterial disease and suffering from intermittent claudication were evaluated using 31phosphorus magnetic resonance spectroscopy (MRS) before and after treatment for 3 months with propionyl-L-carnitine (PLC; 2 g/day p.o.). Maximum walking distance (MWD) was assessed on a standard treadmill (4 km/h, zero incline). For the group as a whole 31P MRS results did not change significantly with PLC. Although MWD increased by a mean of 36%, this change did not reach significance. However, when these variables were assessed with respect to the change in MWD, there were significant differences between those who increased MWD by > 30% (responders, R; n = 5) and those who did not (nonresponders, NR; n = 4). Compared with pretreatment values, during exercise the decrease in muscle pH in R relative to the decrease in phosphocreatine was less after PLC (p = 0.04). After exercise there was a significant inverse correlation between the changes in recovery half-time (t1/2) for phosphocreatine and in MWD (r = -0.91, p = 0.01). With PLC, Vmax increased in R (p = 0.04), but not in NR. For the patient group as a whole, the changes in Vmax and MWD correlated positively (r = 0.90, p = 0.01). This study helps to identify the changes in muscle metabolism that correlate with changes in exercise performance, and may accompany treatment with PLC.

Adenosine Diphosphate↗
PubMed1987

Clinical effects of intravenous iloprost in patients with intermittent claudication.

In a randomized patient-blind study iloprost or hydroxy-ethyl starch 200/0.5 were given i.v. 5 h daily for 2 weeks to 24 patients suffering from severe intermittent claudication due to peripheral vascular disease. An increase in pain-free walking distance of more than 50% occurred in 6 of 11 patients after the iloprost infusions and in 7 of 12 patients after HES treatment. No significant effects on haemodynamic or clinical chemistry tests were observed.

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PubMed1998

[A 56-year-old man with abdominal pain, intermittent claudication and a retroperitoneal mass].

OBJECTIVE: To describe an additional case of idiopathic retroperitoneal fibrosis. METHODS/RESULTS: A 56-year-old man consulted for abdominal pain and previous symptoms of intermittent claudication. A CT scan disclosed a retroperitoneal mass, for which reason the patient was submitted to surgery. Analysis of the biopsy specimen demonstrated retroperitoneal fibrosis. CONCLUSION: Although the clinical diagnosis of this disease is usually based on the CT findings, a histological analysis of the biopsy specimen provides a definitive diagnosis and permits intraperitonization of the ureters, which is the widely accepted treatment, during the same surgical session.

Abdominal Pain↗
PubMedDate not supplied

Effect of beta-blocking drugs on peripheral blood flow in intermittent claudication.

To determine the possible effects of beta-adrenergic blocking drugs on blood flow in arteriosclerotic peripheral vascular disease, we have measured muscle blood flow in eight patients with intermittent claudication who were taking beta-blocking drugs for mild uncomplicated hypertension. Patients completed daily, pindolol 5 mg three times daily, atenolol 100 mg daily, or placebo. Mean exercise muscle blood flow fell by approximately 30% after each active drug when compared to placebo. beta-Blocking drugs may be contraindicated in the presence of peripheral vascular disease. Cardioselectivity and partial agonist activity appear to confer no advantages in such patients.

Adrenergic beta-Antagonists↗
PubMed2001

A role for near infrared spectroscopy in the assessment of intermittent claudication.

BACKGROUND: Near infrared spectroscopy (NIRS) can be used to monitor muscle oxyhemoglobin (HbO2), deoxyhemoglobin (Hb) and cytochrome oxidase (CytOx) oxidation. We evaluated the changes in NIRS in patients with intermittent claudication (IC) pre- and postexercise. Microalbuminuria is an index of endothelial dysfunction. Therefore, we also assessed whether the urinary excretion of albumin increased postexercise in patients with IC. METHODS: Each participant (14 patients with IC and 10 controls) underwent a treadmill test; NIRS was continuously recorded. The urinary albumin:creatinine ratio (ACR) and ankle: brachial systolic pressure index (ABPI) were measured pre- and postexercise. RESULTS: The ABPI in the claudicants dropped significantly (p<0.001) postexercise. The pre-exercise ACR did not differ between claudicants and controls but postexercise, the ACR increased significantly (p<0.001) in the claudicants. There was a significant (p<0.001) difference in the degree of HbO2 deoxygenation between claudicants and controls; the rate of deoxygenation was significantly higher in claudicants than in controls (-8.4 vs. -3.4 mol/L.min, p=0.024). The period of recovery of HbO2 postexercise was also significantly slower in claudicants (192 vs 68 sec, p=0.003). There was a significant correlation between the increase in the ACR and time of recovery of HbO2 levels postexercise (r=0.86, p<0.001, n=24). A similar pattern was seen with CytOx. CONCLUSIONS: NIRS may provide a simple, non-invasive assessment of the severity of IC. Furthermore, because the ACR is a marker of endothelial damage, it is possible that NIRS changes also reflect endothelial integrity. These applications of NIRS technique should be assessed in a larger study.

Aged↗
PubMed1982

Pharmacologic treatment of intermittent claudication.

Twenty-six patients with severe short-distance claudication underwent a 24-week, randomized, double-blind, parallel-group evaluation of the efficacy of pentoxifylline in the treatment of intermittent claudication. The primary variables analyzed were the initial and absolute claudication distances as determined by standardized treadmill walking. A statistically significant improvement in both parameters was present in the pentoxifylline-treated patients. Nausea was the only drug side effect noted.

Double-Blind Method↗
PubMed1992

Intermittent claudication caused by compression of tibial vessels as a result of calf muscle hypertrophy: case report.

We present a case with findings suggestive of popliteal artery entrapment in a patient with intermittent claudication and localized muscle hypertrophy in the calf muscles after removal of a herniated disk. Angiography failed to demonstrate popliteal artery entrapment but instead revealed compression of the tibial vessels caused by calf muscle hypertrophy. The concept of muscle hypertrophy caused by denervation is also discussed.

Humans↗
PubMed1999

Can reactive hyperemia be used instead of exercise test in assessment of mild intermittent claudication.

BACKGROUND AND AIMS: Purpose of the study was to find out if reactive hyperemia stress test could serve as an alternative for treadmill exercise test in assessment of mild intermittent claudication (IC). MATERIAL AND METHODS: A total of 22 claudicants with resting ankle brachial index (ABI) ranging from 0.61 to 1.23 were stressed with progressive treadmill exercise test and suprasystolic thigh occlusion test to provoke reactive hyperemia. Immediate pressure measurements were obtained after the test. RESULTS: ABI drop after progressive exercise test was in average 0.29 and after reactive hyperemia 0.16. The pressures indices after these stress tests correlated well (r = 0.82). The tests were equally good in detecting mild arteriosclerotic disease. CONCLUSIONS: In conclusion, although postexercise ABI was able to detect mild atherosclerotic disease as the reason for IC with a better marginal than hyperemia test both methods are useful. In circumstances where the patient is for some reason unable to carry out treadmill test reactive hyperemia test is an alternative for differential diagnosis. This enables vascular surgeons to improve their diagnostics without vascular laboratory.

Arteriosclerosis↗
PubMed2000

Inhibition of adenosine uptake and augmentation of ischemia-induced increase of interstitial adenosine by cilostazol, an agent to treat intermittent claudication.

Cilostazol (Pletal), a quinolinone derivative with a cyclic nucleotide phosphodiesterase type 3 (PDE3) inhibitory activity, was recently approved by the Food and Drug Administration for treatment of symptoms of intermittent claudication (IC). However, the underlying mechanisms of action are not entirely clear. In this study, we showed that cilostazol inhibited adenosine uptake into cardiac ventricular myocytes, coronary artery smooth muscle, and endothelial cells with a median effective concentration (EC50) approximately 10 microM. In vivo, cilostazol increased cardiac interstitial adenosine levels after a 2-min ischemia in rabbit hearts (329 +/- 92% increase vs. 102 +/- 29% ischemia alone). The combination of cilostazol and 2-min ischemia reduced infarction from subsequent 30-min regional ischemia and 3 h of reperfusion (infarct size was 18 +/- 4% vs. 53 +/- 3% in the hearts with 2-min ischemia alone or 48 +/- 2% in the hearts treated with cilostazol alone). In contrast, milrinone had no effect on either adenosine uptake or interstitial adenosine levels. These data show that cilostazol, unlike milrinone, inhibits adenosine uptake, and thus potentiates adenosine accumulation from a 2-min ischemia. Future studies are needed to investigate the role of adenosine in the treatment of IC by cilostazol.

Adenosine↗
PubMed1985

Update on some epidemiologic features of intermittent claudication: the Framingham Study.

During 26 years of surveillance of the Framingham Study Cohort of 5,209 subjects, 176 men and 119 women developed occlusive peripheral arterial disease manifested as intermittent claudication (IC). The incidence increased sharply with age until the age of 75, with about a twofold male predominance at all ages. An incidence of IC comparable to that of angina pectoris was obtained ten years later in life than for angina pectoris. Cigarette smoking, impaired glucose tolerance, and hypertension were powerful predisposing factors. Impaired glucose tolerance was a greater risk in women than in men, and glycosuria carried a greater risk than other indicators of impaired glucose tolerance. Cigarette smoking had about the same impact in men and women, approximately doubling the risk, and the impact was discernible into advanced age. Hypertension increased risk 2.5- to fourfold, respectively, in men and women. A low vital capacity was associated with a substantial excess risk. Electrocardiographic evidence of left ventricular hypertrophy predicted IC in both sexes. Serum cholesterol, relative weight, and hematocrit were weak risk factors. A risk profile made up of the major cardiovascular risk factors was better for predicting IC than for predicting coronary heart disease. Mortality was increased two- to fourfold in men and women, respectively, mainly because of coexistent cardiovascular disease.

Adult↗
PubMed2001

A primary care walking exercise program for patients with intermittent claudication.

PURPOSE: In a pilot study, the hypothesis was tested that a home-based walking exercise program with structured coaching would improve walking performance and adherence in patients with intermittent claudication (IC). METHODS: Thirty-one IC patients with a rest ankle-brachial pressure index < 0.90 started a 24-wk walking program in the home environment. They were coached according to the Health Counseling Model (HCM). Patients were instructed to walk at least 9 bouts.wk-1 and to walk through the pain. The main effect measures were pain-free (initial claudication distance (ICD)) and maximum walking distance (absolute claudication distance (ACD)) measured with a graded treadmill test, a corridor exercise test, a walking-diary, and the score on the Walking Impairment Questionnaire (WIQ). RESULTS: Twenty-four participants completed the program. The reported walking frequency was 7.4 times.wk-1. The average ICD improved from 289 m (95% CI, 209-369) to 347 m (95% CI, 244-449) (P < 0.05) and from 241 m (95% CI, 171-310) to 373 m (95% CI, 273-472) on the treadmill and the corridor test, respectively. The average ACD improved from 490 m (95% CI, 397-583) to 544 m (95% CI, 438-650) and from 564 m (95% CI, 412-717) to 726 m (95% CI, 546-906) (P < 0.01) on the treadmill and the corridor test, respectively. The average maximum distance reported in the walking-diary improved from 957 m (95% CI, 291-1623) to 1294 m (95% CI, 646-1941). The score of the walking distance on the WIQ improved from 57% (95% CI, 42-71%) to 60% (95% CI, 46-74%). CONCLUSION: IC patients improved their average ICD and ACD. The walking exercise program in the home environment with coaching according to the HCM seems a promising intervention to be tested in a randomized controlled trial.

Adult↗
PubMed2002

Sulodexide in the treatment of intermittent claudication. Results of a randomized, double-blind, multicentre, placebo-controlled study.

AIMS: Patients with peripheral arterial obstructive disease require treatment to prevent major cardiovascular events and to relieve intermittent claudication. The walking performance of peripheral arterial obstructive disease patients was used to evaluate the usefulness of sulodexide, a glycosaminoglycan containing fast moving heparin and dermatan sulphate. METHODS AND RESULTS: A randomized, multicentre, double-blind, placebo-controlled study was performed in 286 patients with Leriche-Fontaine stage II peripheral arterial obstructive disease. Patients received placebo (n=143) or sulodexide (n=143) for 27 weeks. The primary end-point was the doubling of the pain-free walking distance at the end of treatment, and this was achieved by 23.8% of patients treated with sulodexide and 9.1% of those on placebo (P=0.001). The pain-free walking distance increased on average (+/-SE) by 83.2+/-8.6 m (+64.7% from baseline) with sulodexide and 36.7+/-6.2 m (+29.9% from baseline) with placebo (P=0.001). The maximum walking distance increased by 142.3+/-15.8 m (+76.0% from baseline) and 54.5+/-8.4 m (+27.9% from baseline) (P<0.001), respectively. Results for patients with type II diabetes were similar to those for non-diabetic patients. Plasma fibrinogen decreased with sulodexide, but increased with placebo. CONCLUSION: Sulodexide improved the walking ability of peripheral arterial obstructive disease patients to a significantly greater extent than placebo, with a concurrent significant decrease in fibrinogen. The treatment was well tolerated.

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