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PubMed1997

Reliability of transcutaneous oximeter electrode heating power during exercise in patients with intermittent claudication.

The purposes of this study were to (1) compare the reliability of transcutaneous oximeter electrode power with the reliability of oxygen tension and (2) compare the relationship of the oximetry measures with exercise performance in claudicants. One hundred ten PAOD patients with stable claudication symptoms performed a treadmill test and had the following exercise measures obtained: foot transcutaneous oxygen tension, oximeter electrode heating power, exercise duration, and peak oxygen consumption. A subset of 30 patients were tested once per week over three successive weeks to assess the reliability of the oximetry measures. The coefficient of variation of foot transcutaneous oxygen tension at peak exercise was 32.8%, whereas the variability of the oximeter electrode heating power was only 5.1%. Oximeter electrode heating power at peak exercise was related to maximal claudication pain time (r = 0.44, P < 0.001) and peak oxygen consumption (r = 0.36, P < 0.001), whereas foot transcutaneous oxygen tension was not related to either (r = 0.15, P = 0.119; r = 0.13, P = 0.189; respectively). Thus, transcutaneous oximeter electrode heating power was six to seven times less variable than transcutaneous oxygen tension, and the oximeter electrode power at peak exercise was more closely related to exercise capacity. It is concluded that the measurement of transcutaneous oximeter electrode heating power during exercise is more reliable and better correlated with exercise capacity in PAOD patients with intermittent claudication than the measurement of transcutaneous oxygen tension.

Aged↗
PubMed1989

Lactate and pyruvate kinetics after treadmill exercise in patients with intermittent claudication.

Lactate and pyruvate movements in arterial and venous blood during recovery following treadmill exercise in 8 patients with arterial occlusive disease were studied by means of a two-compartment model. Blood lactate and pyruvate concentration curves over the recovery period were found to fit a two-exponential time function including a rapidly increasing and a slowly decreasing component. The velocity constants gamma 2 were dependent on the exercise load. The time of lactate disappearance during recovery decreased with the work load in patients with intermittent claudication. The velocity constant of the arterial blood pyruvate decrease was similar to that of the simultaneously measured lactate indicating that the rate of lactate removal is closely related to that of pyruvate. In conclusion, the use of the model allows to study factors likely to modify the coefficients, such as physical training, therapeutic effects and active recovery.

Adult↗
PubMed1984

Does oxpentifylline ('Trental') have a place in the treatment of intermittent claudication?

In a randomized double-blind study, the clinical and haemorrheological responses of 40 patients receiving oxpentifylline (200 mg 3-times daily) were compared with those of 40 patients receiving placebo. The treatment period in both groups was 2 months. The parameters measured before and after treatment were: subjective response; claudication and maximum walking distances; ankle systolic indices; maximum blood flow in the lower limb by gravimetric plethysmography; plasma fibrinogen; erythrocyte deformability and whole blood viscosity. There was a significant increase (p less than 0.05) in mean erythrocyte deformability in the oxpentifylline group but not in the placebo group; this apparent difference between the groups, however, was not significant. The placebo group showed a significant improvement (p less than 0.05) in claudication distance and mean plasma fibrinogen concentration, but no such improvements were observed in the oxpentifylline group. There were no significant differences in either of the two groups with regard to the subjective response, ankle systolic indices, maximum limb blood flow or whole blood viscosity. It is concluded that oxpentifylline , when taken in oral form at the dose used in this study, increased erythrocyte deformability without conferring any clinical or haemorrheological benefit to patients with intermittent claudication.

Adult↗
PubMed2004

Clinical efficacy of ozonated autohemotherapy in hemodialyzed patients with intermittent claudication: an oxygen-controlled study.

BACKGROUND: Hemodialyzed patients are particularly exposed to the development of peripheral arterial occlusive disease. Ozonotherapy is used as a therapeutic tool in the treatment of this atherosclerotic complication, but there are still no properly designed studies to show the clinical effectiveness of this approach. The aim of this study was to evaluate the influence of ozonated autohemotherapy on walking ability and the subjective clinical experience of hemodialyzed patients with peripheral arterial disease. METHODS: Ten subjects with intermittent claudication (Fontain II stage) received the cycle of ozonated autohemotherapy with ozone concentration of 50 microg/ml and the cycle of oxygen autohemotherapy as a control in a cross-over, single-blind manner. Pain-free distance and maximal walking distance were measured using a standardized march test on a treadmill. The efficacy of therapy was assessed subjectively by patients on a five-degree scale. RESULTS: Significant prolongation of maximal waking distance after ozonated autohemotherapy was found, as compared to the baseline (by 30.5%) and to the oxygen control (by 22.7%) (p<0.01 and p<0.03). There was also significant increase in pain-free distance after ozonated autohemotherapy, as compared to the baseline (by 71.7%) and to the oxygen control (by 62.8%) (p<0.02 and p<0.03 respectively). In a subjective assessment (questionnaires) 90% of patients reported clinical improvement relative to the baseline after ozonated autohemotherapy as compared to 40% after the oxygen-control treatment (p<0.025). CONCLUSION: We demonstrated that ozonated autohemotherapy might prolong walking ability and attenuate subjective clinical signs of ischemia in patients with peripheral arterial disease treated regularly with hemodialysis.

Aged↗
PubMed2002

Intermittent claudication unmasking underlying Fabry's disease.

In a 53-year-old woman, admitted to our Department with leg pain, peripheral arterial occlusive disease (PAOD) was diagnosed. The absence of cardiovascular risk factors in this middle-aged woman, the unexplained burning pain during both effort and rest of the lower extremities mimicking severe ischemia, decreased sweating and cold induced Raynaud's phenomenon raised the suspicion of an underlying predisposing disease. The coexistence of painful acroparesthesias, angiokeratomas, left ventricular hypertrophy (LVH), corneal opacities and lenticular lesions suggested the diagnosis of Fabry's disease, which was confirmed by low serum levels of a-galactosidase-A activity. This case, presented with intermittent claudication due to generalized atherosclerosis, is quite unusual, since Fabry's disease rarely produces symptoms in female carriers.

Fabry Disease↗
PubMed1998

Progressive intermittent claudication is associated with impaired fibrinolysis.

PURPOSE: Acute complications of atherosclerosis such as stroke and myocardial infarction are caused by thrombosis and may be associated with impaired fibrinolytic activity. The current study was performed to determine whether peripheral arterial disease (PAD) and its progression are also associated with impaired fibrinolysis, by measurement of tissue plasminogen activator (tPA, the activator of fibrinolysis) and its inhibitor plasminogen activator inhibitor-1 (PAI-1). METHODS: The study group consisted of 80 men with a mean age of 69 years. This included 18 patients with mild intermittent claudication (MC, pain-free walking distance > or = 200 meters) and 51 patients with severe claudication (SC, walking distance <200 meters). Eleven age- and sex-matched patients without PAD served as controls. All patients had measurements of serum tPA antigen using an enzyme-linked immunoadsorbent assay. Serum levels of tPA and PAI-1 activity were assayed with an amidolytic method. Mean +/- SEM levels of the enzyme levels in patients with progressively more severe PAD were compared with normal controls. RESULTS: Serum PAI-1 activity levels were significantly elevated in both PAD groups compared with normal controls (p < 0.02). There were no significant differences in the PAI-1 activity levels in groups with worsening degrees of PAD. There was a significant decrease in tPA activity levels in patients with SC (p = 0.01) relative to those with MC and the normal subjects. There was also a significant increase in tPA antigen level in the patients with SC compared with those with MC and the control subjects, as well as a significant inverse correlation between tPA antigen levels and pain-free walking time in patients with claudication (p = 0.001). CONCLUSIONS: All patients with PAD in this study had significant reductions in endogenous fibrinolytic activity. Patients with SC had more impaired fibrinolytic activity than those with MC and the control subjects, suggesting that the progression to more severe levels of PAD may be associated with worsening endogenous fibrinolysis.

Aged↗
PubMed1992

Hematocrit dependent changes of muscle tissue oxygen supply in the lower limb muscle of patients with intermittent claudication.

Hematocrit dependent changes of muscle tissue oxygen supply at rest and after exercise were detected in 23 patients with chronical arterial occlusive disease stage IIb according to Fontaine. In these patients with a concomitant high hematocrit a stepwise isovolemic hemodilution by vena esection and subsequent infusion of 10% hydroxyethylstarch solution (200/0.5%) was achieved intraindividually. Measurements of muscle tissue oxygen pressure (pO2) values in the lower limb muscle using a standardized pedalergometric exercise test as well as pain free walking distance with a treadmill were performed. Improvement of muscle tissue pO2 supply after pedalergometric exercise as well as muscular performance on the treadmill were found at an average hematocrit value of 40.50%, whereas muscle tissue oxygen supply and pedalergometric performance were markedly reduced at hematocrit 50.60% as well as 33.75%. Thus it is likely that an improvement of muscle tissue oxygen supply in severe intermittent claudication can be achieved by isovolemic hemodilution to hematocrit values about 40-41%.

Blood Viscosity↗
PubMed1980

Femoropopliteal bypass grafting for intermittent claudication: is pessimism warranted?

From 1965 to 1979, 43 consecutive patients underwent 51 femoropopliteal reconstructions to relieve disabling claudication. This represented 17% of 298 femoropopliteal and femorotibial reconstructions performed by the same surgical team during this period of time. All patients operated on for claudication experienced relief of symptoms after surgery. There was no operative mortality and there was only one case of immediate graft failure. Cumulative graft patency was 93% at two years and 88% at five years by life table analysis. One patient who underwent below-knee amputation 12 years after his initial femoropopliteal graft was the only patient who lost a limb at any time during the follow-up period. On the basis of this experience, we now offer femoropopliteal grafting to any active individual who is disabled by intermittent claudication on the basis of superficial femoral artery occlusive disease.

Adult↗
PubMed1990

Assessment of intermittent claudication by means of the transcutaneous oxygen tension exercise profile.

Transcutaneous oxygen tension was measured simultaneously on both feet during exercise (TcpO2 exercise profile) in patients with claudication. The following groups were studied: 1) 21 control subjects; 2) 25 patients with bilateral claudication of whom eight had unilateral predominance; 3) 40 patients with unilateral claudication. The control group showed no significant decrease in TcpO2 during exercise. Patients with bilateral claudication and unilateral predominance showed a significant decrease in the TcpO2 exercise profile of both feet (P less than 0.05), the decrease in the more affected leg being significantly greater than that of the less affected leg (P less than 0.05). In patients without unilateral predominance of claudication there was a slight, yet significant decrease in TcpO2 of both legs. Patients with unilateral claudication were classified into three groups based on a constant work load of 50 W, which provoked typical leg pain during exercise (group I: 0-2 min; group II: 2-4 min; group III: greater than 4 min). The decrease in the TcpO2 exercise profile was always significant on the symptomatic leg. In the asymptomatic leg TcpO2 did not decrease. The changes in TcpO2 relative to values at rest of the symptomatic leg showed significant differences after 1 min in groups I, II, and III (P less than 0.05). In conclusion, the TcpO2 exercise profile appears to be a suitable objective method by which the peripheral arterial insufficiency during exercise in patients with intermittent claudication can be quantified.

Adult↗
PubMed1998

Demonstration of the efficacy of ginkgo biloba special extract EGb 761 on intermittent claudication--a placebo-controlled, double-blind multicenter trial.

BACKGROUND: A multicentric, randomized, placebo-controlled double-blind study on ginkgo biloba special extract EGb 761 (Tebonin forte) in patients suffering from peripheral occlusive arterial disease (POAD) in Fontaine stage II b was carried out in order to prove its clinical efficacy in this indication according to guidelines of European Community authorities and the German Angiological Society and to confirm the results of former clinical studies with EGb 761. PATIENTS AND METHODS: In total, 111 patients with angiographically proven POAD in Fontaine stage II b and intermittent claudication (pain-free walking distance < 150 m on the treadmill) were recruited in 5 centers and treated with either EGb 761 or placebo at a daily dose of 3 times 1 film-coated tablet over a duration of 24 weeks following a 2-week placebo run-in period. The primary response variable was the difference of the pain-free walking distance between the start of treatment and after 8, 16 and 24 weeks as measured on the treadmill (walking speed 3 km/h and slope of 12%) under standardized conditions. RESULTS: At the start of the treatment period, the mean pain-free walking distances were very similar with 108.5 m in the EGb 761 group and 105.2 m in the placebo group. At the end of the treatment period these values increased to 153.2 m and 126.6 m, respectively. The group differences were statistically significant at all three control visits with p = 0.017, p = 0.007, and p = 0.016. The differences for the maximum walking distance and the relative increases of the pain-free walking distance and the maximum distance were also significantly higher in the EGb 761 group with p-values < 0.05 each. In both groups Doppler indices remained nearly unchanged during therapy. The subjective assessment of the patients demonstrated an amelioration of complaints in both groups. Tolerability was very good with no adverse events under EGb 761 and one case of heartburn and gastric pain in the placebo group. CONCLUSIONS: It can be concluded from the results of this study that treatment with EGb 761 in POAD patients with Fontaine stage II b is very safe and causes a significant and therapeutically relevant prolongation of the patients' walking distance.

Aged↗
PubMed2003

Regional angiogenesis with vascular endothelial growth factor in peripheral arterial disease: a phase II randomized, double-blind, controlled study of adenoviral delivery of vascular endothelial growth factor 121 in patients with disabling intermittent claudication.

BACKGROUND: "Therapeutic angiogenesis" seeks to improve perfusion by the growth of new blood vessels. The Regional Angiogenesis with Vascular Endothelial growth factor (RAVE) trial is the first major randomized study of adenoviral vascular endothelial growth factor (VEGF) gene transfer for the treatment of peripheral artery disease (PAD). METHODS AND RESULTS: This phase 2, double-blind, placebo-controlled study was designed to test the efficacy and safety of intramuscular delivery of AdVEGF121, a replication-deficient adenovirus encoding the 121-amino-acid isoform of vascular endothelial growth factor, to the lower extremities of subjects with unilateral PAD. In all, 105 subjects with unilateral exercise-limiting intermittent claudication during 2 qualifying treadmill tests, with peak walking time (PWT) between 1 to 10 minutes, were stratified on the basis of diabetic status and randomized to low-dose (4x10(9) PU) AdVEGF121, high-dose (4x10(10) PU) AdVEGF121, or placebo, administered as 20 intramuscular injections to the index leg in a single session. The primary efficacy end point, change in PWT (DeltaPWT) at 12 weeks, did not differ between the placebo (1.8+/-3.2 minutes), low-dose (1.6+/-1.9 minutes), and high-dose (1.5+/-3.1 minutes) groups. Secondary measures, including DeltaPWT, ankle-brachial index, claudication onset time, and quality-of-life measures (SF-36 and Walking Impairment Questionnaire), were also similar among groups at 12 and 26 weeks. AdVEGF121 administration was associated with increased peripheral edema. CONCLUSIONS: A single unilateral intramuscular administration of AdVEGF121 was not associated with improved exercise performance or quality of life in this study. This study does not support local delivery of single-dose VEGF121 as a treatment strategy in patients with unilateral PAD.

Adenoviridae↗
PubMed2004

Atherothrombotic risk factor clustering in healthy male relatives of male patients with intermittent claudication.

OBJECTIVE: Family history is an independent risk factor for premature acute myocardial infarction; in contrast, familial risk for peripheral arterial disease (PAD) has yet to be determined. Elevated levels of hemostatic proteins are consistently predictive for cardiovascular risk in "healthy" subjects, and may cluster with underlying insulin resistance. Atherothrombotic risk factor clustering occurs in first-degree relatives of subjects with coronary artery disease and type 2 diabetes. These may contribute to the enhanced cardiovascular risk in these subjects, and we hypothesised that familial clustering may occur in PAD. The objective of this study was to measure atherothrombotic risk factors in healthy male first-degree relatives of men with intermittent claudication, with emphasis on thrombotic risk. METHODS: One hundred sixty-five healthy male first-degree relatives were compared with control subjects matched for age, sex, and race (n = 165), free from a personal or family history of premature cardiovascular disease. Primary outcome measures were fibrinogen, von Willebrand factor, factor VII clotting activity (FVII:C), and factor XIII levels. Atherosclerotic risk factors were measured, and subjects were genotyped for common functional polymorphisms (factor VII r353q and fibrinogen B beta-455). RESULTS: Relatives had higher mean levels of fibrinogen (3.04 vs 2.89 g/L; P = .021), FVII:C (117% vs 104%; P = .000), factor XIII B subunit (1.11 vs 1.01 IU/mL; P = .000), and complex (A 2 B 2 ; 1.18 vs 1.11 IU/mL; P = .021). At multivariate analysis the association between relative status and fibrinogen, FVII:C, and factor XIII B subunit levels were independent of other variables. CONCLUSIONS: The healthy male relatives of men with PAD have elevated levels of fibrinogen, factor VII, and factor XIII. Our results support the existence of thrombotic risk factor clustering in this population at "high risk."

Adolescent↗
PubMed2006

[A 26-year-old cyclist with intermittent claudication].

A 26-year-old male amateur cyclist, with no risk factors for vascular disease or previous trauma, presented with left-calf claudication. Physical and additional examination revealed an occlusion of the external iliac artery. During the operation, the cause was found to be an endofibrotic lesion of the external iliac artery, probably due to mechanical trauma as a result of the non-physiological aerodynamic position held on the bicycle during many hours of training. An endarterectomy was performed and the tendon of the psoas-minor muscle was cut because of its strong impression on the psoas-major muscle, which resulted in kinking of the external iliac artery. There followed two episodes of re-occlusion which were treated with a venous interposition graft and a dacron interposition graft, respectively. Thereafter the patient was able to train without pain. Intermittent claudication of the legs in young athletes should not be underestimated; occlusive vascular disease caused by arterial endofibrosis should be considered.

Adult↗
PubMed1999

Vascular surgical society of great britain and ireland: limb outcome following failed femoropopliteal polytetrafluoroethylene bypass for intermittent claudication

BACKGROUND: Femoropopliteal (FP) bypass using polytetrafluoroethylene (PTFE) is still considered by many surgeons to be a reasonable procedure for severe intermittent claudication (IC) without limb-threatening ischaemia. The consequences of FP graft failure were examined. METHODS: Over 8 years, 54 patients had 55 FP grafts (that subsequently occluded) inserted for severe IC (42 PTFE and 13 vein grafts) above (30) or below (25) the knee. There were no operative deaths. During the same interval a total of 191 FP grafts were placed, 100 of which were vein grafts. Patient demography and risk factor analysis was similar for both groups. RESULTS: Nineteen patients required amputation subsequent to a failed graft, all of these following PTFE grafts. Mean time to occlusion was 12.2 (range 0-79) months. For PTFE grafts, the mean(s. d.) ankle index rose from 0.51(0.14) to 0.95(0.15) after operation but fell to 0.25(0.15) after occlusion, confirming a highly significant deterioration from preoperative levels, which was not seen in vein graft occlusions. CONCLUSION: Long-term FP bypass patency rates with vein are superior to those obtained with PTFE. Failed PTFE grafts show a significant deterioration in pressure indices compared with preoperative values. FP grafts for IC carry an intrinsic risk of limb loss which is much greater when vein is not used (P < 0.001).

Journal Article↗
PubMed1992

Effect of intensive walking exercise on skeletal muscle blood flow in intermittent claudication.

Walking exercise is generally accepted as a valid therapeutic regimen in the treatment of peripheral arterial occlusive disease (PAOD) of Fontaine stage II. In order to quantify the effect of walking exercise and/or drug therapy on regional muscular blood flow, PAOD Fontaine stage II was induced by multiple ligations of the femoral artery and of all side branches in one hindlimb of mongrel dogs; the contralateral extremity served as control. The animals underwent walking exercise with increasing intensities on a treadmill five days per week over one year; one group received 600 mg buflomedil (BF) per day orally in addition. At the end of the training period, the regional blood flow in all skeletal muscles of both hindlimbs was quantified by means of 15 microns radioactively labeled microspheres at resting conditions, after treadmill exercise (ten minutes) with or without preinjection of BF (3 mg/kg body weight) into the abdominal aorta. At resting condition and at the end of treadmill exercise the regional muscular blood flow did not differ significantly between the diseased and control extremity. Supplementary oral treatment with BF over one year had no significant effect; the increase in muscular blood flow during treadmill exercise was not enhanced after intra-aortic injection of BF. Consequently walking exercise has the potential to increase the functional capacity of collaterals in intermittent claudication and to restore blood supply to skeletal muscle.

Administration, Oral↗