Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “CLAUDICATION, INTERMITTENT”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources
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↗
PubMed1997

Intermittent claudication. A risk profile from The Framingham Heart Study.

BACKGROUND: Intermittent claudication identifies persons at increased risk for death and disability. METHODS AND RESULTS: Using 38-year follow-up data for the original cohort in the Framingham Heart Study, we developed an intermittent claudication risk profile. Intermittent claudication occurred in a total of 381 men and women. Age, sex, serum cholesterol, hypertension, cigarette smoking, diabetes, and coronary heart disease were associated with an increased risk for claudication and were included in the profile. A pooled logistic regression model was used to compute the probability of intermittent claudication for specified levels of risk factors. CONCLUSIONS: The intermittent claudication risk profile allows physicians to identify high-risk individuals during a routine office visit and can be used to educate patients about modifiable risk factors, particularly smoking and blood pressure. Improved compliance with risk factor modification strategies may result in a beneficial impact on survival.

Adult↗
PubMed2002

Efficacy of a short-course intensive rehabilitation program in patients with moderate-to-severe intermittent claudication.

BACKGROUND: Many rehabilitation programs for intermittent claudication include physical training for several months, since the outcome of short-course protocols is still unclear. The aim of this study was to evaluate the efficacy of a short course of exercise therapy in patients with moderate-to-severe intermittent claudication in terms of walking distance variations. METHODS: Twenty-six patients (males 88%, mean age 59 +/- 8 years, ankle-brachial index < or = 0.8 and < or = 0.5 before and after exercise respectively) were evaluated. Moderate-to-severe stenoses or occlusions were localized at color Doppler scanning of the abdominal aorta/iliac arteries and femoral/popliteal/tibial arteries in 15 and 31% of patients respectively, while in 54% of cases both the proximal and distal sites were involved. The initial and absolute claudication distances were recorded by means of the constant treadmill test (3 km/hour speed, 0% grade) at the time of presentation and after a short-course comprehensive rehabilitation program (4 week duration) including physical training, educational intervention, psychological support, and cardiovascular risk management. RESULTS: At the end of the program, 1 patient (4%) became asymptomatic (walked > 1000 m without pain). In 25 patients who still developed pain, the average increase in the initial claudication distance was 132% (from 75 to 174 m). Among these, 20 patients (77%) were still unable to complete the treadmill test due to maximal claudication pain, but the absolute claudication distance increased by 87% from 204 to 381 m (p < 0.05). No cardiovascular complication occurred during the study period. Major clinical variables failed to predict an unsatisfactory increase in walking capacity. CONCLUSIONS: Short-course training programs enhance the walking ability even in patients with moderate-to-severe intermittent claudication and seem to be well tolerated, supporting their widespread use in rehabilitation centers.

Aged↗
PubMed1994

Colour duplex ultrasound: a screening modality for femoropopliteal disease in patients with intermittent claudication.

In patients presenting with intermittent claudication, Colour Duplex Ultrasound (CDU) examination of the femoro-popliteal segment has been proposed as a screening modality. Those patients with atheromatous lesions suitable for percutaneous transluminal angioplasty (PTA) could proceed to diagnostic angiography. Patients with long segment occlusive disease demonstrated by CDU, who were not considered suitable candidates for surgery, would not require angiographic examination. This prospective study was performed on 46 limbs in 25 consecutive patients who presented for investigation of claudication. There was close correlation between the two methods in the demonstration of high-grade stenoses and occluded segments. Using angiography as the 'gold standard' this study indicated a diagnostic accuracy for CDU of 93% with a sensitivity of 89% and a specificity of 95%. Angiography tended to show longer occluded segments than CDU. Colour Duplex Ultrasound shows promise as a screening investigation in patients with intermittent claudication to detect lesions that may be suitable for PTA.

Aged↗
PubMed1995

Intermittent claudication. The natural history.

Intermittent claudication is a relatively common disorder, present in a subset of patients with lower extremity atherosclerotic disease. Although lower extremity morbidity rates are low, patients with claudication frequently have coexistent cardiovascular disease and are at significantly increased risk of adverse cardiovascular events. Data to support work-up for concomitant coronary artery disease in conservatively managed patients are not available; however, clinicians should consider the high prevalence of coronary artery disease when developing management strategies. Patients should be carefully selected for lower extremity interventional management given the generally benign lower extremity prognosis. Tobacco smokers should be urged to quit, owing to their higher rate of lower extremity and cardiovascular adverse outcomes. Functional outcomes after various treatment strategies have not yet been sufficiently studied in the claudicant.

Adult↗
PubMedDate not supplied

Medical management of intermittent claudication.

The symptoms of intermittent claudication (IC) lead sufferers to seek medical attention, potentially leading to substantial workup and invasive testing. However, only a minority of people with IC develop limb-threatening ischemia or symptoms of significant lifestyle-limiting claudication. Patients with IC have a substantial risk of concomitant cardiovascular and cerebrovascular disease. Assessment of co-morbidities and control of risk factors reduce the cardiovascular risk of these patients. A multitude of drugs have been developed and tested in numerous trials for the symptoms of IC. Although no drug alone offers a "cure" to IC, some are used as adjuvant therapy to reduce claudication symptoms.

Cardiovascular Agents↗
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↗
PubMed1991

[Intermittent claudication].

The symptom of intermittent claudication indicates a generalised arteriosclerosis. The high mortality of these patients is due to myocardial infarction, cerebrovascular events and rupture of aortic aneurysms. Prognostic factors for the progression of peripheral occlusive arterial disease to rest pain and trophical lesions are persistent nicotine consumption, arterial occlusions on more than one extremity, brachiopedal pressure quotient less than 0.5 and diabetes mellitus. Therapy of choice in most cases is the walking exercise. When the claudication distance remains very short or decompensation of peripheral circulation is imminent, reopening procedures like percutaneous transluminal angioplasty should be performed. If they are successless a prostanoid therapy is able to relief the complaints.

Combined Modality Therapy↗
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↗
PubMed1991

Leg showering therapy in patients with intermittent claudication.

Ten patients with intermittent claudication were treated using a recently constructed "chair" in which the seated patient has alternately warm and cool water flushed over the legs and feet. A trial treatment was given for 25 minutes, three times a week for 5 weeks. Ankle/arm index, skin perfusion pressure and calf blood flow all remained unchanged immediately after such a series of treatment. Even at follow-up 6 months later, values were unchanged but for a minute increase in ankle/arm index in the poorer leg. Walking capacity was additionally measured and an improvement was seen, also after 6 months. The role of the contrast temperature treatment in this improvement is, however, unclear.

Aged↗
PubMed1989

Diabetes, intermittent claudication, and risk of cardiovascular events. The Framingham Study.

The impact of diabetes on intermittent claudication was examined in 1813 men and 2504 women with 34-yr follow-up data in the Framingham study. For both sexes, diabetes was associated with a two- to threefold excess risk of intermittent claudication compared with its absence. A pronounced excess risk was also observed in subjects on oral hypoglycemic therapy and in women receiving insulin. Although diabetes was often associated with an atherogenic-risk profile, controlling for age and several concomitant risk factors failed to eliminate the association with intermittent claudication. Those who developed both intermittent claudication and diabetes were at an especially high risk of incident cardiovascular events. In women, the risk of coronary heart disease, stroke, and cardiac failure was increased 3-4 times when diabetes and intermittent claudication occurred together compared with when either condition existed alone. In diabetic men, the presence of intermittent claudication doubled the risk of stroke, and cardiac failure was approximately 3 times more likely in subjects with both conditions compared with either alone. We conclude that diabetes is an important risk factor for intermittent claudication, which in turn confers a serious prognosis for subsequent cardiovascular outcomes in the patient with diabetes.

Blood Glucose↗
PubMed2002

Gait analysis of patients with neurogenic intermittent claudication.

STUDY DESIGN: The gait of patients with neurogenic intermittent claudication was analyzed before and after surgery using a ground reaction force plate. OBJECTIVES: To analyze the gait characteristics of patients with neurogenic intermittent claudication, to evaluate quantitatively their gait improvement after surgical treatment, and to examine the differences in gait characteristics and postoperative improvement among different types of neuropathy. SUMMARY OF BACKGROUND DATA: A number of reports have been published on the pathophysiology or treatment of neurogenic intermittent claudication. However, almost no detailed reports exist on the gait abnormalities associated with this condition. METHODS: The subjects were 60 lumbar canal stenosis patients with intermittent claudication who underwent surgery at the authors' hospital. A ground reaction force plate was used for the analysis, and factors related to time and distance (speed, stride, interval, and pitch) were analyzed, as well as factors related to the style of walking (symmetry, reappearance, smoothness, sway, rhythm, and impact). RESULTS: Before surgery, there were abnormalities of various factors related to the style of walking soon after the patients began to walk. Gait analysis also showed that the pattern of gait abnormality and its improvement after surgery varied depending on the type of neuropathy. CONCLUSIONS: Gait analysis permits objective and quantitative evaluation of the gait characteristics of patients with lumbar canal stenosis and is useful for evaluating responses to surgical treatment in these patients.

Aged↗
PubMed1994

[Positive effect of intermittent overpressure and underpressure (Vacusac) in intermittent claudication].

Twenty-two patients with intermittent claudication were included in a double-blinded, randomized trial comparing the effects of 25 treatments with intermittent suction and pressure (Vacusac treatment) to 25 placebo applications given over a period of two months. Twelve patients participated in an open trial investigating the effects of the same treatment on adenosine diphosphate (ADP)-induced platelet aggregation and fibrinolysis. Active treatment resulted in significant improvements in pain-free and maximal walking distances, whereas no changes could be found during placebo application. Active treatment caused significant increments in ADP-induced platelet aggregation, while the effects on fibrinolysis were uncertain. It is concluded that intermittent suction and pressure treatment offers a new approach for conservative treatment of intermittent claudication.

Aged↗
PubMed1985

Evaluation of the patient with intermittent claudication.

The most common cause of intermittent claudication is atherosclerotic occlusive arterial disease. Differentiation of the common musculoskeletal and neurologic conditions that may mimic intermittent claudication is often possible with a careful history, but when insufficient detail is provided or multiple conditions exist, the findings on physical examination and noninvasive studies are useful. While physical examination provides a rough estimate of the degree of ischemia, assessment of functional impairment produced by occlusive arterial disease is best made with noninvasive studies before and after standard exercise. Arteriography is reserved for the patient for whom restoration of pulsatile flow is planned.

Angiography↗
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↗
PubMed1999

Exertional leg symptoms other than intermittent claudication are common in peripheral arterial disease.

BACKGROUND: Epidemiological data show that most community-dwelling men and women with lower-extremity peripheral arterial disease (PAD) do not have typical symptoms of intermittent claudication. We compared the prevalence of intermittent claudication, leg symptoms other than intermittent claudication, and absence of exertional leg symptoms between patients with PAD identified from a blood flow laboratory (group 1), patients with PAD in a general medicine practice (group 2), and control patients without PAD (group 3). METHODS: Numbers of participants in groups 1, 2, and 3 were 137, 26, and 105, respectively. Patients with previously diagnosed PAD were excluded from groups 2 and 3. All participants underwent ankle-brachial index measurement and were administered the San Diego claudication questionnaire to assess leg symptoms. RESULTS: Within groups 1, 2, and 3, prevalences of intermittent claudication were 28.5% (n = 39), 3.8% (n = 1), and 3.8% (n= 4), respectively. Prevalences of exertional leg symptoms other than intermittent claudication were 56.2% (n= 77), 42.3% (n= 11), and 19.0% (n = 20), respectively. Absence of exertional leg symptoms was reported by 15.3% (n= 21), 53.8% (n= 14), and 77.1% (n=81), respectively. Among patients with PAD, older age, male sex, diabetes mellitus, and group 2 vs group 1 status were associated independently with absence of exertional leg symptoms in multivariable regression analysis. Lower ankle-brachial index levels and group 1 vs group 2 status were associated with intermittent claudication. CONCLUSIONS: Clinical manifestations of PAD are diverse, particularly among patients identified by ankle-brachial index screening. Exertional leg symptoms other than intermittent claudication are common in PAD. Patients with PAD who are older, male, diabetic, or identified with ankle-brachial index screening in a primary care setting are more likely to have asymptomatic PAD.

Age Factors↗
PubMed1992

The ischemic window: a method for the objective quantitation of the training effect in exercise therapy for intermittent claudication.

Twenty-two patients with intermittent claudication were prospectively enrolled in a 12-week program of supervised, graded treadmill exercise therapy. Severity and distribution of arterial occlusive disease were ascertained by noninvasive determination of segmental lower extremity blood pressures and waveforms. No attempt was made to modify risk factors for atherosclerotic occlusive disease. The exercise-induced reduction of the ankle pressure and its recovery were recorded over time, and the area under this curve, the "ischemic window," represents the severity of the ischemic deficit. Absolute systolic ankle pressure, ankle-brachial index, maximum walking time, claudication pain time, and the ischemic window were measured before and after exercise training in all subjects. Maximum walking time and claudication pain time increased 659% and 846%, respectively, among the 19 patients completing the 12-week program (p = 0.001; p = 0.0002). These patients underwent a mean reduction of 58.7% in the ischemic window after a standardized workload (p less than 0.05), and this correlated with the degree of symptomatic improvement. Absolute ankle pressure and ankle-brachial index were unchanged after exercise training. This study confirms the utility of supervised exercise therapy in the treatment of intermittent claudication. The ischemic window is a useful method for quantifying the ischemic deficit produced by exercise and provides a reproducible means of documenting functional improvement in patients undergoing exercise training.

Aged↗
PubMed2005

Lacunar stroke in patients with intermittent claudication.

OBJECTIVES: To compare the characteristics of lacunar stroke (LS) in patients with and without intermittent claudication. MATERIAL AND METHODS: Data of 484 consecutive patients with LS were collected from a prospective hospital-based stroke registry in which 2500 patients are included. RESULTS: Of the 142 patients with ischemic stroke and intermittent claudication, 39 (27.5%) had LS (8% of all lacunes). In the multivariate analysis, small centrum ovale topography (odds ratio 7.35), carotid stenosis >50% (odds ratio 3.17), and absence of limitation at discharge (odds ratio 2.01) were independent variables significantly associated with LS in patients with intermittent claudication. CONCLUSION: Only 8% of patients with LS had intermittent claudication. The short-term prognosis is good with a spontaneous early neurological recovery at discharge in 51.3% of patients. LS patients with intermittent claudication showed a striking similarity in risk factors and clinical syndromes in comparison with the LS patients without intermittent claudication.

Aged↗