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PubMed1988

[Spinal claudication following ileocaval venous thrombosis].

The case is reported of a young male who presented with intermittent claudication after thrombosis of the right common femoral, iliac and caval vein. The symptoms were explained by the severe proximal venous obstruction. The patient, however, also complained of lumbar pain during and long after walking, and showed signs of irritation of nerve roots L4 to S1 on the right side. Venography and CT-scan disclosed venous collateral circulation leading through the spinal canal. The blood drained through the foramina intervertebralia to the caval vein, causing compression of the nerve roots depending on their filling. Thus, the claudication was "venous" in two ways, muscular (due to inadequate drainage) and spinal (due to intermittent compression of lumbar nerve roots by the collateral circulation).

Adult↗
PubMed1988

Percutaneous transluminal angioplasty of infrarenal arteries in intermittent claudication.

Percutaneous transluminal angioplasty was performed on 55 iliac and 31 femoropopliteal arteries in 71 patients with intermittent claudication (23 women, 48 men). The two-year patency rate was 80% after iliac and 41% after femoropopliteal angioplasty. In 17 femoropopliteal cases with lesions greater than or equal to 5 cm the 2-year patency rate was only 32%, but the corresponding figure for shorter lesions was 53%. Complicating haematoma appeared in 10% of the cases and the arterial state deteriorated in one patient. There was no distal embolization. Percutaneous transluminal angioplasty in intermittent claudication is indicated for all cases of occlusion or stenosis of the iliac artery and for occlusion or stenosis shorter than 5 cm of the superficial femoral or the popliteal artery.

Adult↗
PubMed1979

Diagnostic work-up of patients with intermittent claudication.

In this paper a number of techniques are described that provide information concerning the functional disturbances caused by anatomic lesions within the vascular system in patients with intermittent claudication. These techniques are part of a currently growing entity that is called the "Vascular Laboratory". Main characteristics of these techniques are that they are painless, atraumatic and without any danger to the patient. Therefore, they can both be used for diagnosis as well as for follow-up of the patients. Moreover, many of them are useful for detecting stenotic lesions at an early stage of evolution. In any patient with intermittent claudication, the walking distance, oscillography at rest and after exercise and systolic blood pressure determination should be performed. Segmental plethysmography is extremely sensitive mainly when performed together with systolic blood pressure determination. Venous occlusion plethysmography has been significantly improved in recent years and is capable of providing direct information concerning the circulation through the diseased limb. There seems to be tremendous improvement in the techniques using ultrasound allowing presently construction of an anatomic picture of the vessels (Ultrasonic arteriography).

Blood Pressure↗
PubMed1988

[Cystic adventitial degeneration of the popliteal artery: an unusual cause of intermittent claudication].

The case is reported of a 44-year-old patient without cardiovascular risk factors who complained of typical intermittent claudication. Arteriography and echography led to the diagnosis of cystic adventitial disease of the popliteal artery. Percutaneous puncture under CT control was unsuccessful and surgical resection of the cystic formation was performed. This rare etiology is discussed in relation to the differential diagnosis of intermittent claudication, with particular reference to young patients.

Cysts↗
PubMed1987

[Phosphorus-31 NMR spectrometry of the calf muscles in patients with arterial claudication. Preliminary results].

Phosphorus NMR spectrometry allows non-invasive exploration in vivo of certain aspects of muscle energy metabolism. A study was conducted in 10 healthy volunteers and 12 patients with lower limb affections (stage II claudication) to define a precise methodology and to discuss perspectives offered by this new method, in the light of preliminary findings. Changes with time of amplitude of peaks of phosphocreatine (Pcr), inorganic phosphorus (Pi) and ATP, and of intracellular pH, showed that recovery of 80% of resting value of the ratio Pcr/Pi + Pcr after quantified exercise is a very discriminatory parameter correlated with severity of arteriographic findings in patients with claudication.

Energy Metabolism↗
PubMed1987

Angina pectoris, intermittent claudication and congestive heart failure in middle-aged male hypertensives. Development and predictive factors during long-term antihypertensive care. The Primary Preventive Trial, Göteborg, Sweden.

A group of middle-aged male hypertensives, derived from a random sample of a Swedish urban population, has been treated and followed for 10 years. The development of angina pectoris, intermittent claudication and congestive heart failure have been analysed. The initial prevalence and the average yearly incidence of angina pectoris was 3.9% and 1.3% p.a., of intermittent claudication 1.7% and 0.6% p.a. and of heart failure 1.0% and 0.8% p.a. ECG signs indicating subclinical heart disease (major Q wave, ST depression, T wave inversion) were risk factors for development of angina pectoris and congestive heart failure. Heart enlargement on chest X-ray was also a risk factor for development of congestive heart failure, as were a high serum creatinine, body mass index, serum uric acid and proteinuria. Smoking was found to be a strong and independent risk factor for any one of these cardiovascular disorders. After 10 years about one fourth of all patients, still attending the clinic, had at least one cardiovascular complication. Hence, the risk of developing cardiovascular disorders is substantial and seems to be potentiated by the same risk factors known to operate in the general population.

Actuarial Analysis↗
PubMed1987

Personality factors in intermittent claudication related to the outcome of self-care program.

The relationship between personality factors in intermittent claudication and the patient's compliance with the therapeutic regimen was studied. Fifty-three patients with intermittent claudication were clinically examined, interviewed and tested with the Wechsler Intelligence Test, the Rorschach Test and the Ceasarec-Marke Inventory. The patients were given self-care program with four recommendations. After half a year, the clinical examinations and interviews were repeated. The results showed that the compliance with self-care program was relatively poor. Hostility, aggressiveness and affect-lability were obstacles to compliance. Obsessive-compulsive and dependent patients as well as those with strong guilt feelings followed the regimen best.

Adult↗
PubMed1987

Cessation of smoking in patients with intermittent claudication. Effects on the risk of peripheral vascular complications, myocardial infarction and mortality.

The effects of cessation of smoking were studied in 343 patients with intermittent claudication. One year after the initial examination 39 (11%) had stopped smoking and 304 (89%) continued to smoke. The outcome in these two groups was compared. They were comparable regarding baseline characteristics. Rest pain did not develop in any of the non-smokers. In smokers the cumulative proportion with rest pain was 16% after seven years (p less than 0.05). The cumulative proportions with myocardial infarctions after 10 years were 11 and 53%; the cumulative rates of cardiac deaths 6 and 43%; and the 10-year survival 82 and 46% among non-smokers and smokers, respectively. In multivariate Cox regression analyses the association between smoking and infarction (p less than 0.05) and cardiac death (p less than 0.05) was significant. The survival curves deviated and when they were compared after one year's follow-up the association between smoking and mortality was significant (p less than 0.05). The findings provide further evidence for the fact that it is of utmost importance that patients with intermittent claudication stop smoking.

Aged↗
PubMed1987

Prediction of the effect of training on the walking tolerance in patients with intermittent claudication.

The possibility of predicting the effect of training on the walking tolerance in intermittent claudication has been studied. After three months of supervised training in 54 patients, the maximal walking distance (MWD) increased by 67% and the painfree walking distance (PFD) by 91%. The analysis of the relation between tested background variables and the effect of training showed covariation only in 14% of the increase in MWD and in 19% of the increase in PFD. The possibility of predicting the effect of training on the walking tolerance in the individual patient with intermittent claudication is limited.

Aged↗
PubMed1987

Claudication as a rare symptom of recurrent cervical carcinoma.

Diagnosis of recurrent cervical cancer can be very difficult in the heavily irradiated pelvis. Sciatica and lymphedema are well-known symptoms of disease recurrent to the side wall. The isolated symptom of claudication is reported as an early sign of recurrence. Two patients are presented in whom claudication was the only early presenting symptom. This symptom in a patient with a history of a gynecologic malignancy should lead to an evaluation for recurrent cancer as well as the routine vascular studies.

Adenocarcinoma↗
PubMed1987

A single treadmill exercise test does not accurately quantitate claudication.

The diagnosis of vascular occlusive disease is confirmed by documenting a fall in the ankle-brachial pressure index following a treadmill exercise test. The authors hypothesize that this test does not provide a reproducible quantitative assessment of the patient's disability due to the disease. In 25 patients a series of five treadmill exercise tests were performed on the same day. There was a significant (p less than 0.05) increase in the time to the occurrence of claudication when tests 3, 4 and 5 were compared with test 1. There was also a significant (p less than 0.05) rise in the maximum time walked comparing test 3 with test 1. There was no difference in the fall in ankle-brachial pressure index with each test. The majority of patients had achieved their maximum walking distance by test no. 3. It is concluded that a single treadmill exercise test will not accurately assess disability due to intermittent claudication and it is recommended that three tests be performed for a reproducible evaluation.

Blood Pressure↗
PubMed1985

Fate of claudicants after femoropopliteal vein bypass: prospective, long-term follow-up of 100 patients.

Femoropopliteal bypass grafting for claudication is a controversial procedure. One hundred consecutive patients so treated were analysed for vein-graft patency, subsequent operation and survival. Initial success, treatment of incipient graft failure and attrition from death were the three critical factors influencing long-term benefit. Cumulative graft patency, after revision when necessary, was 89%, 86% and 78% at 2, 5 and 10 years respectively. In assessing the real benefit of surgery in this group, it is important to consider the effect of late deaths, as the life expectancy of these patients is so often shortened by related disease; the "cumulative palliation" (patient alive and graft patent) was 82%, 67% and 28% at the same time intervals. The concept of cumulative palliation sets a high standard in assessing results of vascular surgery, adding important information to the usual graft patency rates that ignore the effect of death. These results suggest a place for femoropopliteal vein bypass grafting in selected claudicants.

Femoral Vein↗
PubMed1985

[Evaluation of intermittent claudication using a treadmill with measurement of systolic pressure at the ankle following exercise].

Intermittent claudication (IC) and maximum walking distance (MWD) were studied in 173 patients and compared to post-stress Doppler claudicant ankle pressure (PSCAP) and to ankle index (PSCAI) recorded 2 minutes after exercise. Self-evaluation of MWD by the patient was inaccurate in 60% of cases. The treadmill testing (at 12% of rate and 2 miles/hour) exhibited a clinically overt IC in 93 cases with MWD of 166 m +/- 76, a PSCAP of 24 mm Hg +/- 24 and a PSCAI of 0.17 +/- 0.17. A clinically questionable IC occurred in 50 cases with significantly higher values (p less than 0.001) for MWD (278 m +/- 75) PSCAP (52 mm Hg +/- 24) and PSCAI (0.34 +/- 0.16). In 30 cases without IC after 400 m on treadmill, the PSCAP (81 mm HG +/- 26) and the PSCAI (0.57 +/- 0.18) were significantly (p less than 0.001) higher than in IC groups and related to milder iliofemoral stenosis. Overall reproducibility of MWD (mean = 190 m +/- 90) with 2 or 3 repeated measures in 75 cases, was 10.8% +/- 8.6 with large individual variations. Overall reproducibility of PSCAP after standardized treadmill testing in 42 cases was 6.5 +/- 5.3 (range of CV = 0 to 16%). A variation of PSCAP of more than 15 mm Hg is considered significant at level 0.01. It is concluded that overt IC with foot pallor and PSACP at 40 mm Hg or less reflects actual and reproducible MWD (especially below 300 m).(ABSTRACT TRUNCATED AT 250 WORDS)

Ankle↗
PubMed1979

The reproducibility of the treadmill walking test for claudication.

Two standard treadmill walking tests were carried out one week apart upon 117 patients with stable claudication. Although total walking time achieved was reproducible, there was a highly significant delay in the onset of pain during the second test. Absolute limb pressures, determined by Doppler, were reproducible for the group as a whole, although individual variation could be significant. A single walking test is an inadequate assessment of claudication.

Blood Pressure↗
PubMed1977

Striated muscle ultrastructure in intermittent claudication.

Twenty-four biopsy specimens from the lower leg muscles of 21 patients with intermittent claudication were studied by electron microscopy. Sixteen of the specimens contained hypertrophic, atrophic, autolytic, or phagocytic fibers, or other forms of macroscopic fiber degeneration. Of the pathological changes in the cell organelles, the most common was simple myofibrillar degeneration, followed by slightly pathological mitochondria and excessive accumulations of glycogen and lipofuscin. Different types of basement membrane alterations and central nuclei were present in 16 of the biopsy specimens. Most of the pathological changes were the same as those previously reported by others to occur in specific diseases of muscle. There was some positive correlation of the degree of pathological changes to the estimated clinical severity of claudication.

Aged↗
PubMed1977

Skeletal muscle capillaries in intermittent claudication.

The ultrastructural dimensions and density of capillaries in 23 gastrocnemius or rectus femoris muscles in patients with intermittent claudication due to arteriosclerosis obliterans (ASO) were studied. Constant ultrastructural alterations that were not seen in the control patients were thickening, replication, and remnants of the capillary basement membrane (BM). Compared with the control patientes, the percentual area of the BM was significantly larger (P less than .01), the lumen was significantly smaller (P less than .01), and the ratio of capillaries to muscle fiber was significantly higher (P less than .01) in patients with ASO. These changes were probably due to ASO since they increased with growing severity of claudication.

Aged↗
PubMed1984

The effects of physical training and flunarizine on walking capacity in intermittent claudication.

The clinical significance of drugs improving red cell deformability is not confirmed. We established the effect of physical training alone and combined with flunarizine on intermittent claudication. Twelve patients aged 48-73 years were included in the study. Pain-free walking distance on treadmill, ankle/arm pressure ratio and transcutaneous oxygen tension were measured. Walking distance increased significantly (p less than 0.05) by 130% from 75 m to 173 m during the first year when the patients were on programmed physical training. Ankle/arm pressure ratio also increased significantly (p less than 0.05) from 0.46 to 0.55 during this period. The increase in walking distance ceased when the programmed physical training was discontinued for 6 months. During the following double-blind, cross-over medication period the patients were given flunarizine 5 mg b.i.d. and placebos in randomized order for 3 months each. They also continued the same programmed physical training as during the first year. Walking distance increased, albeit not significantly, with time to 392 m after the second medication period. There was no difference, however, between flunarizine and placebo. Ankle/arm pressure ratio was of the same magnitude as at the beginning of the trial. Oxygen tension measurements did not give consistent results. We conclude that programmed physical training increased walking distance as a function of time. Flunarizine had no effect on the performance of patients with intermittent claudication.

Aged↗
PubMed1983

Effect of treadmill exercise on blood gases and acid-base balance in patients with intermittent claudication.

Blood gases and lactate and pyruvate concentration were measured in arterial and popliteal venous blood in 6 control subjects and 34 patients with intermittent claudication before, during, and after treadmill exercise of 10 min duration. Oxygen saturation, oxygen extraction, base excess, and standard bicarbonate were calculated. The transition from resting supine position to upright position on the treadmill caused the popliteal venous oxygen saturation to fall from 49.4% to 26.3%. In patients, during exercise a further decrease (to 11%) was observed. During treadmill exercise the popliteal venous PO2 did not fall below 16.5 +/- 1.1 mm Hg in the controls. Individual values during exercise varied between 6.4 mm Hg and 17.9 mm Hg in patients. A critical oxygen pressure was reached in 10 patients. Lactate concentration was found to increase to values as high as 14 mmol/l in popliteal venous blood. The lactate-pyruvate ratio varied between 12.9 and 106.3 during exercise, and the corresponding values for venous blood pH were 7.38 and 6.92. Changes in the PCO2, lactate, and pH in arterial and popliteal venous blood showed a significant correlation. The decrease in the base excess was greater than the corresponding increase in the blood lactate concentration. It is concluded that analysis of the acid-base balance in patients with intermittent claudication is best carried out by the regional catheterization technique.

Acid-Base Equilibrium↗