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PubMed1984

[Isosorbide dinitrate ointment in the long-term treatment of intermittent claudication].

We evaluated the long-term therapy with Isosorbide Dinitrate Ointment (ISDN-O): 300 mg daily on the painful leg area in 20 male patients (pts) affected by Intermittent Claudication. The efficacy of the treatment was assessed on the basis of the subjective evaluation of pain threshold (daily diary) and objectively by repeated treadmill stress tests performed by each patient at a constant speed, selected according to the severity of symptoms, and by the evaluation of changes both of the distance walked without symptoms (DWS) and of the maximal distance reached (MDR). The maximal duration of the test was 15 minutes independently from the speed. The reproducibility of treadmill tests and the acute effect of isosorbide dinitrate ointment administration were preliminarly evaluated in 2 groups of 5 patients each. The distance walked without symptoms and maximal distance reached in two control stress tests performed in two successive days were: distance walked without symptoms 37 +/- 29 vs 36 +/- 22 m (NS) and maximal distance reached 97 +/- 40 vs 98 +/- 37 m (NS). During the control period and 1 hour after the drug administration distance walked without symptoms was 34 +/- 31 vs 43 +/- 50 m (NS) and maximal distance reached 89 +/- 53 vs 97 +/- 57, (NS) respectively. In a group of 5 patients the effect of one month administration of placebo was evaluated: distance walked without symptoms was m 68 +/- 29 and m 104 +/- 62 and maximal distance reached was m 156 +/- 103 and m 188 +/- 97 basally and after 1 month of placebo (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Laser Doppler flowmetry, transcutaneous oxygen pressure and thermal clearance in patients with vascular intermittent claudication.

In the present study, heat thermal clearance (HTC) was compared to laser Doppler flowmetry (LDF) and transcutaneous oxygen pressure (tcPO2), measured on the forefoot of 17 patients with vascular intermittent claudication and 10 controls in various positions at rest and after a treadmill exercise test. The mean ankle brachial systolic pressure ratio (ABSP) of the patients, measured using ultrasonic Doppler velocimetry, was 0.53 +/- 0.05. Their walking distance was 480 +/- 100 meters, the treadmill exercise being stopped as soon as pain sensation. No statistically significant difference was found between patients and controls for HTC, LDF, tc P02, forefoot and ankle skin temperatures. Statistically significant differences between patients and controls occurred in the sitting position for tcPO2, in standing position for HTC and after treadmill exercise for tcPO2 and LDF. When assuming the sitting position HTC did not vary significantly in patients and decreased in controls, LDF decreased and tcPO2 increased in both groups. After treadmill exercise, HTC in patients did not vary compared to supine values and HTC decreased in controls, tcPO2 remained unchanged in controls and decreased in patients, LDF increased in controls and decreased in patients. No significant correlations were found between the different techniques measured at rest in patients and controls. However in patients, after the treadmill test, LDF correlated with the walking distance (r = 0.667) and with ABSP (r = 0.641), HTC inversely correlated with the walking distance (r = -0.680) and ABSP (r = -0.577). Laser Doppler, tcPO2 and HTC are useful as tools to understand the alterations of cutaneous microcirculation of the lower limbs in patients with V.I.C.. However their results need to be interpreted with caution because these methods do not measure directly blood flow.

Adult↗
PubMed1989

HLA antigens, blood groups and serum protein groups in patients with intermittent claudication.

HLA (A and B) antigens, blood group systems (AB0, Rh, MNSs P, Kell, Lewis and Duffy) and serum group systems (Hp, Tf, Pi, C3 and C4) were studied in patients with intermittent claudication (IC) and controls. HLA antigen A 28 was significantly more common, and blood group 0 was significantly less common among the patients than among the controls. A comparison between patients with IC and those with abdominal aortic aneurysms showed a significant difference between these two groups concerning the MN blood groups.

Adult↗
PubMed2000

Functional status and walking ability after lower extremity bypass grafting or angioplasty for intermittent claudication: results from a prospective outcomes study.

OBJECTIVE: The purpose of this study was the prospective comparison of functional outcomes after lower extremity bypass grafting surgery, angioplasty, or medical management of intermittent claudication. METHODS: The study was designed as a prospective cohort study to compare functional outcomes for patients with interventional management to medical management, including a matched (younger, with more disability) subgroup, followed for a mean of 19 months. Sixteen Chicago-area vascular surgery clinics participated in the study. The subjects were consecutively enrolled patients with an abnormal ankle-brachial blood pressure index (ABI), without signs of rest pain, ulcer, or gangrene, and without prior lower extremity revascularization procedures. The main outcome measures were changes in physical functioning, community walking distance, bodily pain, leg symptoms, and ABI. RESULTS: Of the 526 study patients, 20% underwent revascularization procedures (60 surgical bypass grafting and 44 angioplasty only). The mean ABI improved significantly for the patients who underwent bypass grafting surgery (0.20; P <.001) and modestly for the patients who underwent angioplasty (0.09; P <. 05). Patients undergoing bypass grafting and angioplasty maintained highly significant (P <.001) improvements in mean physical functioning, (17%, 14%), bodily pain (18%, 13%), and walking distance (28%, 27%) scores and reported greater leg symptom improvement. The results were far superior for the patients with greater improvement in ABI. The conditions of the 277 unmatched patients who underwent medical management declined on all outcome measures, and the conditions of the 145 matched patients who underwent medical management improved 5% (P <.001) on walking distance score. Eighteen percent of the study patients failed to complete the full study follow-up period. CONCLUSION: Most of the functional improvement achieved by patients who underwent interventional management appears to be related to improved patency rather than to selection bias or placebo effects. The functional gains were approximately half those often reported for patients for hip arthroplasty and similar to patients who undergo elective coronary angioplasty.

Activities of Daily Living↗
PubMed1986

The effect of beta-blockade on leg blood flow in hypertensive patients with intermittent claudication.

The present study was designed to assess the short-term effects of beta-blocking antihypertensive treatment on leg blood flow in patients with peripheral artery disease. Seven patients with intermittent claudication were randomly allocated to treatment with atenolol 100 mg or pindolol 10 mg. Patients switched therapy after one month of treatment. Venous occlusion plethysmography on the calves was used to assess the effects on leg blood flow after one and two months of treatment. The average 10% reduction of the systolic and diastolic blood pressures was not associated with any reduction of blood flow at rest. There was on average 3.4 ml reduction of peak flow which had no influence on the painfree or total walking distance.

Adult↗
PubMed1992

Significant association between low-molecular-weight apolipoprotein(a) isoforms and intermittent claudication.

The role of lipoprotein(a) (Lp[a]) and apolipoprotein(a) (apo[a]) isoforms in symptomatic peripheral atherosclerosis was studied in 100 randomly selected middle-aged (45-69 years) men with intermittent claudication (IC) and 100 randomly selected healthy control (C) subjects. IC and C subjects were matched pairwise for sex, age, and smoking habits. Plasma Lp(a) concentrations were significantly higher in IC subjects, with a median value of 20.12 mg/dl, compared with 11.11 mg/dl in C subjects (p less than 0.0009). The elevated Lp(a) concentration was to a great extent due to a significant difference in the frequency distribution of apo(a) isoforms between IC and C subjects (p less than 0.029). Low-molecular-weight apo(a) isoforms were more prevalent in IC than C subjects. Also, IC subjects with apo(a) S2 and S3 phenotypes had higher Lp(a) concentrations than control subjects with the same phenotypes: S2:60.70 mg/dl (IC) and 48.69 mg/dl (C), p less than 0.038; and S3: 30.18 mg/dl (IC) and 12.01 mg/dl (C), p less than 0.042, so other still-unknown factors, genetic or nongenetic, may be important. Stepwise logistic regression analysis demonstrated that Lp(a) concentration contributed significantly (p less than 0.0002) to IC, independent of age, smoking, hypertension, diabetes mellitus, plasma total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, apo B, and plasma total triglycerides. Apo(a) isoforms grouped according to molecular weight were also independent of the above risk factors associated (p = 0.016) with the occurrence of IC because of their low-molecular-weight but were not independent of Lp(a) concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

A method for evaluating drug effects on intermittent claudication using a treadmill in rats with unilateral hindlimb artery occlusion.

INTRODUCTION: We have developed an in vivo experimental model for evaluating peripheral arterial insufficiency and predicting the efficacy of drugs on intermittent claudication (IC). We found that rats that had been running normally on a treadmill developed a gait disturbance when a hindlimb artery was unilaterally occluded. We hypothesized that the distance run before gait disturbance developed (DGD) in rats with occlusion of a hindlimb artery might be an appropriate index of the severity of peripheral insufficiency, and that the model might serve as a test bed for evaluating drug efficacy. To prove this hypothesis, we examined whether DGD was determined by severity of hindlimb ischemia. Furthermore, we also examined whether cilostazol, which has been proved to have ameliorative effects in patients with IC, increased DGD. METHODS: To vary the severity of ischemia, either the superficial femoral artery, the distal portion of the iliac artery, or the proximal portion of iliac artery was unilaterally occluded. After a recovery period, these rats were subjected to a treadmill test (15 m/min and 15% incline) to determine DGD and examine the effect of cilostazol on DGD. RESULTS: DGD was the longest and shortest in rats with superficial femoral artery and proximal portion of iliac artery occlusion, respectively. Intermediate DGD was observed in rats with distal portion of iliac artery occlusion. These data suggest that DGD is correlated with the severity of hindlimb ischemia. Two weeks or longer administration of cilostazol 30 and 100 mg/kg twice a day evoked a significant increase in DGD. DISCUSSION: Peripheral arterial insufficiency and its modulation by drugs can be evaluated in rats with unilateral hindlimb artery occlusion, on a treadmill, by measuring DGD.

Animals↗
PubMed1982

Pentoxifylline efficacy in the treatment of intermittent claudication: multicenter controlled double-blind trial with objective assessment of chronic occlusive arterial disease patients.

The efficacy, safety, and tolerance of pentoxifylline (Trental, Hoechst-Roussel Pharmaceuticals, Inc.) in the treatment of intermittent claudication associated with chronic occlusive arterial disease (COAD) were evaluated in a double-blind, placebo-controlled, parallel-group, multicenter clinical trial involving a total of 128 outpatients. The response to treatment was ascertained at regular intervals during the trial by measuring the distance walked prior to the onset of claudication when patients were subjected to a standardized treadmill test. Pentoxifylline given orally in doses up to 1200 mg/day was significantly more effective than placebo in increasing both the initial and absolute claudication distances in patients with COAD. Reduction of lower limb paresthesias also suggested greater clinical improvement in the pentoxifylline treated patients. These results support the hypothesis that pentoxifylline reduces blood viscosity by improving red cell flexibility, and thereby enhances blood flow in patients with COAD. White the precise mode of therapeutic action requires clarification, pentoxifylline was well tolerated with minimal unwanted effects.

Aged↗
PubMedDate not supplied

Intermittent claudication in diabetics: treatment with exercise and pentoxifylline--a 6-month, controlled, randomized trial.

The aims of this study were to evaluate the effect of PXF (1600 mg daily) in diabetic patients with intermittent claudication. Of the 60 included patients, 53 completed the study (27 in the PXF group). There were seven dropouts. The groups were comparable for age, sex distribution, and total walking distance (TWD), and risk factors. There was an increase in TWD at 3 and 6 months in both groups (p<0.05) possibly due to exercise. However the increase (both absolute and percentage) in TWD was significantly larger in the PXF group. At 6 months, PXF produced a 292% increase in TWD (vs 180% produced by placebo) (p<0.02). The excess increase produced by PXF treatment was 112% at 6 months in comparison with placebo (p<0.02). Treatment was well tolerated. Between-group analysis favors PXF considering TWD, and results indicate good efficacy and tolerability.

Aged↗
PubMed1996

[Load tests in silent myocardial ischemia and latent heart failure in patients with IHD and intermittent claudication].

244 patients with ischemia of the lower limbs were treated surgically in the specialized cardiovascular center. No lethal outcomes were reported because previously derived algorithm of detecting silent myocardial ischemia in patients with intermittent claudication and load tests (bicycle ergometry and drug stress tests) had allowed the surgeons to ascertain the extent of coronary damage and detect subclinical cardiac failure. Valid assessment of cardiac factors enabled the right choice between surgical and therapeutic methods and staging of the procedures.

Arteriosclerosis↗
PubMed1994

[Cystic adventitial degeneration. A rare cause of intermittent claudication].

Cystic adventitial disease of the popliteal artery is an unusual condition of uncertain etiology in which a mucin-containing cyst forms in the wall of the popliteal artery and causes symptoms of intermittent claudication. The patient is typically a young non-smoking male, whose arteries otherwise are normal. Arteriography may show a smooth-walled narrowing or a non-specific complete occlusion, but may also be normal. Non-invasive imaging techniques may be helpful. We report two cases of cystic adventitial disease. Both were successfully operated on with resection of the diseased arterial segment and vein bypass interposition.

Adult↗
PubMed1998

Effect of the novel antiplatelet agent cilostazol on plasma lipoproteins in patients with intermittent claudication.

Cilostazol is an antiplatelet agent and vasodilator marketed in Japan for treatment of ischemic symptoms of peripheral vascular disease. It is currently being evaluated in the United States for treatment of symptomatic intermittent claudication (IC). Cilostazol has been shown to improve walking distance in patients with IC. In addition to its reported vasodilator and antiplatelet effects, cilostazol has been proposed to have beneficial effects on plasma lipoproteins. We examined the effect of cilostazol versus placebo on plasma lipoproteins in 189 patients with IC. After 12 weeks of therapy with 100 mg cilostazol BID, plasma triglycerides decreased 15% (P<0.001). Cilostazol also increased plasma high density lipoprotein cholesterol (HDL-C) (10%) and apolipoprotein (apo) A1 (5.7%) significantly (P<0.001 and P<0.01, respectively). Both HDL3 and HDL2 subfractions were increased by cilostazol; however, the greatest percentage increase was observed in HDL2. Individuals with baseline hypertriglyceridemia (>140 mg/dL) experienced the greatest changes in both HDL-C and triglycerides with cilostazol treatment. In that subset of patients, HDL-C was increased 12.2% and triglycerides were decreased 23%. With cilostazol, there was a trend (3%) toward decreased apoB as well as increased apoA1, resulting in a significant (9.8%, P<0.002) increase in the apoA1 to apoB ratio. Low density lipoprotein cholesterol and lipoprotein(a) concentrations were unaffected. Cilostazol treatment resulted in a 35% increase in treadmill walking time (P=0.0015) and a 9.03% increase in ankle-brachial index (P<0.001). These results indicate that in addition to improving the symptoms of IC, cilostazol also favorably modifies plasma lipoproteins in patients with peripheral arterial disease. The mechanism of this effect is currently unknown.

Adrenergic beta-Antagonists↗
PubMed1996

Neuromuscular disorders in patients with intermittent claudication.

OBJECTIVE: To evaluate the effect of claudication on nerve function in patients with unilateral peripheral arterial disease. DESIGN: Prospective study. SETTING: District hospital, The Netherlands. SUBJECTS: 11 Patients with unilateral intermittent claudication (diagnosed from history and ankle-brachial blood pressure index) underwent electrophysiological studies of both legs, including nerve conduction velocities, motor unit action potentials, H-reflex measurements, and muscle strength testing. The asymptomatic leg was used as the control in each case. RESULTS: Six patients had neuropathy in both the claudicating and the control leg. Three other patients had neuropathy in the claudicating leg only, which consisted mainly of disorders of nerve conduction including the H-reflex. There was no clear difference between muscle strength in the symptomatic and control legs, possibly because more than half the patients studied, had neuropathy in both legs. CONCLUSIONS: Neuropathy is common at an early stage of arterial disease and could be one of the factors leading to impaired muscle function in such patients.

Action Potentials↗
PubMed1993

Blood viscosity during long-term treatment with ticlopidine in patients with intermittent claudication. A double-blind study.

The aim was to test within a randomized, double-blind trial whether the antiaggregant drug ticlopidine might reduce blood viscosity as has been claimed. Sixteen patients with intermittent claudication were studied before and after three years of treatment with ticlopidine, 500 mg/day, or placebo. At baseline, the viscosity values were significantly higher as compared with a reference group of healthy subjects. Whole-blood viscosity, measured at four different shear rates at hematocrit adjusted to a standard 40%, decreased significantly at follow-up, with no difference between ticlopidine treatment and placebo. Hematocrit showed a slight increase in the placebo group. The viscosity parameters were unrelated to lower limb blood flow variables, ankle/brachial index, and walking distances. The mechanism behind the overall decrease in whole-blood viscosity is obscure but could possibly be explained by lifestyle changes. Smoking habits were, however, unaltered. Since plasma viscosity remained increased, it might indicate that some erythrocyte factor, notably red cell aggregability and deformability, had improved. It is concluded that ticlopidine had no long-term effect on blood viscosity.

Aged↗
PubMed1978

Calf blood flow and ankle systolic blood pressure in intermittent claudication monitored over five years.

The response of calf blood flow and ankle blood pressure to 2 minutes of ischemic exercise were recorded every 6 months over a 5-year period in 9 patients with intermittent claudication who were treated conservatively on a regime including alpha tocopherol. No statistically significant change was noted in the pattern of the calf blood flow response over this period. Statistically significant (P less than 0.05) increases in resting and minimal postexercise ankle systolic pressures were partially attributable to a concomitant increase in central arterial pressure as indicated by brachial systolic pressure. Results from 18 patients over 1 year and from 14 patients over 2 years are consistent with these findings. The evidence presented suggests that the arterial disease process was stable over this period.

Ankle↗
PubMedDate not supplied

Treatment of intermittent claudication: two different mechanisms.

(1) After surgical reconstruction in patients with isolated arterial occlusions, prolongation of walking distance depends on the increase in blood flow, i.e. the improvement of muscular working capacity is due to a "flow mechanism". (2) After medical therapy, the prolongation of walking distance does not depend on the response of total blood flow. This is most probably attributable to a shift of blood to muscle capillaries, i.e. the improvement of muscular working performance is due to a "distribution mechanism". (3) Combined therapeutic use of both mechanisms may ensure optimal results in the treatment of intermittent claudication.

Humans↗
PubMed2000

PGE(1) treatment of severe intermittent claudication (short-term versus long-term, associated with exercise)--efficacy and costs in a 20-week, randomized trial.

The efficacy, safety, and cost of prostaglandin E1 (PGE1) in the treatment of severe intermittent claudication was studied comparing a long-term treatment protocol (LTP) with a short-term treatment protocol (STP) in a randomized 20-week study. The study included 980 patients (883 completed the study) with an average total walking distance of 85.5 +/-10 m (range 22-119). Phase 1 was a 2-week run-in phase (no treatment) for both protocols. In LTP, phase 2 was the main treatment phase. In the LTP, treatment was performed with 2-hour infusions (60 microg PGE1, 5 days each week for 4 weeks. In phase 3 (4-week interval period) PGE1 was administered twice a week (same dosage). In phase 4 (monitoring lasting 3 months, from week 9 to 20) no drugs were used. In STP phase 2 treatment was performed in 2 days by a 2-hour infusion (first day: morning 20 microg, afternoon 40 microg; second day morning and afternoon 60 microg). The reduced dosage was used only at the first cycle (week 0) to evaluate tolerability or side effects. Full dosage (60 microg bid) was used for all other cycles. The same cycle was repeated at the beginning of weeks 4, 8, and 12. The observation period was between weeks 12 and 20. A treadmill test was performed at inclusion, at the beginning of each phase, and at the end of 20th week. A similar progressive physical training plan (based on walking) and a reduction in risk factors levels plan was used in both groups. Intention-to-treat analysis indicated an increase in walking distance, which improved at 4 weeks and at 20 weeks in the STP more than in the LTP group. At 4 weeks the variation (increase) in pain-free walking (PFWD) was 167.8% (of the initial value) in the LTP group and 185% in the STP group (p<0.05). At 4 weeks the variation (increase) in total walking distance (TWD) was 227.6% of the initial value in the LTP group and 289% in the STP group (p<0.05). At 20 weeks the increase in PFWD was 496% of the initial value in the LTP group vs 643% in the STP group (147% difference; p<0.02). The increase in TWD was 368% in the LTP group and 529% in the STP group (161% difference; p<0.02). In both groups there was a significant increase in PFWD and TWD at 4 and 20 weeks, but results obtained with STP are better considering both walking distances. No serious drug-related side effects were observed. Local, mild adverse reactions were seen in 6.3% of the treated subjects in the LTP and 3% in the STP. Average cost of LTP was 6,664 Euro; for STP the average costs was approximately 1,820 E. The cost to achieve an improvement in walking distance of 1 m was 45.8 E with the LTP and 8.5 E with the STP (18% of the LTP cost; p<0.02). For an average 100% increase in walking distance the LTP cost was 1,989 E vs. 421 E with STP (p<0.02). Between-group analysis favors STP considering walking distance and costs. Results indicate good efficacy and tolerability of PGE, treatment. With STP less time is spent in infusion and more in the exercise program. STP reduces costs, speeds rehabilitation, and may be easily used in a larger number of nonspecialized units.

Aged↗