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PubMed1975

[The concept of neurogenic intermittent claudication. A rare form of intermittent limping in neurologic system disease].

Two cases of neural muscular atrophy of the Charcot-Marie-Tooth-Hoffmann type with strain-dependent pain in the leg similar to intermittent claudication are reported. While the pathogenesis of a neurogenic intermittent claudication appears to be reasonably explained by a pathological narrowness of the lumbar spinal duct, this question must remain open in the cases of neurospinal systemic disease described.

Arterial Occlusive Diseases↗

PubMed1994

Pentoxifylline therapy for chronic claudication: are patients dependent on therapy?

BACKGROUND: The purpose of this study was to evaluate the efficacy of long-term pentoxifylline therapy. METHODS: Fifty consecutive patients on long-term pentoxifylline therapy entered a weaning program. The standard dose of 400 mg three times a day was reduced to 400 mg twice a day for 1 month, 400 mg daily for an additional month, and then withdrawn completely for 3 months. Subjective evaluation of each patient's symptoms and objective measurements (treadmill testing for initial claudication distance, maximum walking distance, and ankle/brachial indexes) were evaluated during treatment withdrawal. RESULTS: Twenty-seven patients tolerated withdrawal of therapy without symptomatic deterioration. Seven of nine patients who did not tolerate weaning had deterioration of treadmill ICD/MWD parameters; there was a significant absolute decrease (p = 0.016) in MWD from 430 +/- 78 to 221 +/- 23 feet. Patients with an initial low MWD were less likely to tolerate weaning. Sixty percent of the patients with successful weaning had clinically asymptomatic deterioration of treadmill ICD/MWD parameters. CONCLUSIONS: A substantial number of patients who have been on long-term successful pentoxifylline therapy for claudication can be weaned from the drug. Asymptomatic deterioration of treadmill test parameters is not an indication for resuming therapy.

Aged↗

PubMed1993

Double-blind, controlled, multicenter study of indobufen versus placebo in patients with intermittent claudication.

The objective of the study was to evaluate the efficacy and safety of indobufen compared with placebo in the treatment of moderately severe intermittent claudication. The study consisted of a four-week single-blind, placebo-controlled run-in phase, followed by a six-month double-blind randomized treatment period. A total of 302 patients were allocated to treatment with either placebo (154 patients) or indobufen (148) 200 mg twice daily. The results of the overall intention-to-treat analysis of the study population showed statistically significant superiority of indobufen over placebo after six months for both the initial (ICD) and absolute claudication distances (ACD). The ICD before treatment with indobufen or placebo averaged 137.9 +/- 68.2 and 136.6 +/- 63.2 m (mean +/- SD), respectively. After six months' treatment with active drug or placebo, this parameter reached 227.9 +/- 174.4 and 153.1 +/- 86.8 m (mean +/- SD), respectively (p < 0.01). Similar results were obtained on ACD. The reduction of lower limb symptoms also suggested a greater clinical benefit in the indobufen-treated patients. There was no significant change in either group in the ankle/arm pressure ratio at the end of treatment. Adverse events of any type were reported by 18 patients (12.2%) in the indobufen group and by 11 patients (7.2%) in the placebo group. The mechanism whereby the drug is effective in this clinical condition could be related to both its antiplatelet and hemorheologic effects.

Double-Blind Method↗

PubMed1993

Nonatherosclerotic claudication.

Lower extremity claudication typically reflects the presence of significant atherosclerotic arterial obstructive disease. However, a group of nonatherosclerotic conditions may cause similar symptoms and a keen appreciation of these unusual conditions is essential for the fully trained vascular surgeon. Typical atherosclerotic risk factors may or may not be present among patients with nonatherosclerotic claudication. However, the astute vascular surgeon can diagnose these nonatherosclerotic conditions with a carefully focused history and physical examination followed by optimally selected noninvasive testing and imaging studies. Once accurately diagnosed, effective and durable treatments are generally available for this heterogeneous group of patients.

Arteriosclerosis↗

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↗

PubMed1993

Variability of TcPO2-measurements at 37 degrees C and 44 degrees C in patients with claudication in consideration of provocation tests.

With regard to the increasing use of tcPO2-measurements for the assessment of peripheral arterial occlusive disease, the variability of the method needs more consideration. We studied the reproducibility of tcPO2 measured at 37 degrees C and 44 degrees C, especially under the influence of provocation tests, in 21 patients with severe claudication (ankle artery pressures (AP) 30-100 mmHg) without skin lesions. On 6 days within 2 weeks tcPO2 was recorded on the forefoot at 37 degrees C and 44 degrees C electrode core temperatures a) in supine position, b) in sitting position, c) during O2-breathing, d) during reactive hyperemia (RH). In measurements at 37 degrees C variation coefficients (VC) were high (mean +/- S.D.: 74 +/- 27%) and could not be improved by oxygen inhalation nor by the sitting position. Only during RH, VC decreased significantly to 49 +/- 23%. At 44 degrees C VC were still quite high (mean: 42 +/- 24%) and were inversely correlated with AP. Mean tcPO2 increased under all provocation maneuvers. However, only in the sitting position VC decreased significantly to 18.7 +/- 8.4% (p < 0.001). Single tcPO2 measurements, both at 37 degrees C and 44 degrees C, are of low value in patients with severe claudication. For the evaluation of the individual patient repeated measurements are demanded. Reduced variability may be achieved by measurements at 44 degrees C in a sitting position.

Adult↗

PubMed1993

The effect of a combined administration of ridogrel and ketanserin in patients with intermittent claudication.

After a 1-month placebo run-in phase, 27 patients with proven peripheral arterial obstructive disease participated in a double blind placebo controlled study and were divided in 3 groups, receiving either placebo, ridogrel 300 mg b.i.d. (a combined thromboxane synthase and receptor blocking agent) or a combination of ridogrel 300 mg b.i.d. and ketanserin 20 mg t.i.d. (a 5-HT2 serotonergic receptor antagonist) for a period of 1 month. In both active treatment groups, serum levels of thromboxane B2 decreased significantly to 3% of baseline. The levels of 6-keto-prostaglandin F1 alpha and prostaglandin F2 alpha increased two- to three-fold and levels of prostaglandin E2 6 times. Platelet aggregation induced by collagen and by U 46619, a thromboxane A2 mimetic, were significantly inhibited by both treatment regimen. Template bleeding times were significantly prolonged but plasma fibrinogen levels and the activated partial thromboplastin time were not affected with the active treatments. No such changes were seen with placebo. An inhibition of the serotonin-induced platelet aggregation was only seen in the ketanserin-treated group. In a 3-month open follow-up period during combined treatment with ridogrel and ketanserin in 22 patients, the effects on platelet function and prostanoids were maintained. The total duration of the walking distance on a treadmill improved significantly from 323 +/- 53 seconds to 399 +/- 48 seconds and the onset of claudication pain improved significantly from 121 +/- 29 seconds to 212 +/- 44 seconds, whereas the maximal drop of the post-exercise ankle/arm pressure gradient markedly and significantly improved from a control value of 0.38 +/- 0.05 to 0.51 +/- 0.05. These findings suggest that a combination of ridogrel and ketanserin may be of therapeutic value in the treatment of intermittent claudication.

Aged↗

PubMed1996

Claudication: diagnosis and treatment.

Claudication is exercise-induced lower extremity pain that is caused by ischemia and relieved by rest. This underreported condition affects at least 10 percent of persons over 70 years of age and 2 percent of those 37 to 69 years of age. Claudication is usually caused by atherosclerotic narrowing of the arteries that supply blood to the lower extremities. The diagnosis may be suspected based on the history and the physical examination, and it is confirmed by Doppler segmental pressures and an ankle/brachial index. Initial treatment includes vigorous risk factor modification and an exercise program. Further treatment includes pentoxifylline and, occasionally, endovascular or bypass procedures.

Algorithms↗

PubMed1996

[Ginkgo biloba in treatment of intermittent claudication. A systematic research based on controlled studies in the literature].

The aim of this systematic review was to evaluate the effectiveness of ginkgo biloba in the treatment of intermittent claudication. A Medline-search identified ten controlled trials on the subject. These were heterogeneous in all respects and, with only few exceptions, of poor methodological quality. All the studies implied that ginkgo biloba is an effective therapy for intermittent claudication. This hypothesis should be confirmed in further trials employing meticulous methodology. Furthermore it would also be important to determine whether oral ginkgo biloba can be usefully combined with walking exercise.

Clinical Trials as Topic↗

PubMed1996

[Placebo-controlled double-blind study of the effectiveness of Ginkgo biloba special extract EGb 761 in trained patients with intermittent claudication].

This monocenter, randomized, placebo-controlled double-blind study with parallel-group comparison was carried out in order to demonstrate the efficacy of Ginkgo biloba special extract EGb 761 on objective and subjective parameters of the walking performance in trained patients suffering from peripheral arterial occlusive disease in Fontaine stage IIb. In total 60 patients were recruited (42 men; aged 47-82 years) with angiographically proven peripheral arterial occlusive disease of the lower extremities and an intermittent claudication existing for at least 6 months. No improvement had been shown despite consistent walking training and a maximum pain-free walking distance on the treadmill of less than 150 m was recorded at the beginning of the study. The therapeutic groups were treated with either Ginkgo biloba special extract EGb 761 at a dose of 3 times 1 film-coated tablet of 40 mg per day by oral route or placebo over a duration of 24 weeks following a two-week placebo run-in phase. The main outcome measure was the difference of the walking distance between the start of treatment and after 8, 16 and 24 weeks of treatment as measured on the treadmill (walking speed 3 km/h and slope of 12%). As secondary parameters the corresponding differences for the maximum walking distance, the relative increase of the pain-free walking distance, the Doppler index and the subjective evaluation of the patients were analyzed. The absolute changes in the pain-free walking distance in treatment weeks 8, 16 and 24 as against the treatment beginning (median values with 95% confidence interval) led to the following values for the patients treated with Ginkgo biloba special extract EGb 761:19 m (14, 33), 34 m (18, 50) and 41 m (26, 64). The corresponding values in the placebo group were as follows: 7 m (-4, 12), 12 m (5, 22) and 8 m (-1, 21). The advantage of the EGb 761-treated group as compared to the placebo group could be verified statistically at the 3 time points with p < 0.0001, p = 0.0003 and p < 0.0001. The test for the presence of a clinically relevant difference of 20% between EGb 761 and placebo also produced a statistically significant result (p = 0.008). The Doppler index remained unchanged in both therapeutic groups: A corresponding statistically significant advantage for the EGb 761 group was observed on a descriptive level for the other parameters tested. The tolerance of the treatment was very good. The results of this placebo-controlled study show that treatment with Ginkgo biloba special extract EGb 761 produces a statistically highly significant and clinically relevant improvement of the walking performance in trained patients suffering from intermittent claudication with very good tolerance of the study preparation.

Aged↗

PubMed1996

An objective evaluation of muscle oxygen content in claudicants receiving drug therapy.

The effects of medical treatment with a prostaglandin I2 analog (beraprost sodium) were evaluated in 19 of 120 cases studied with near-infrared spectroscopy (NIRS) from January 1993 to September 1994. The relative changes in oxygenated (Oxy) and deoxygenated (Deo) hemoglobin (Hb) in the calf muscle were measured during a treadmill walking test and the subsequent recovery period. After medical treatment in these 19 cases, recovery time of OxyHb decreased in 10 cases, increased in 7 cases and remained unchanged in two cases. Pressure studies did not facilitate the assessment of changes in the severity of claudication. Our results demonstrate that NIRS can provide objective information regarding the effects of medical therapy in claudicants.

Aged↗

PubMed1977

Surgical management of intermittent claudication.

The distribution of claudication reflects the anatomic site of stenosis or occlusion. Palpable pedal pulses do not rule out proximal stenosis, nor do weak pulses certify leg pain as claudication. An initial conservative approach is not appropriate for patients with rest pain, ulcers, gangrene, rapid increase in discomfort or dangerous lesions involving major collateral vessels. Early surgical treatment is also advisable for patients whose occupations are in jeopardy. Complete arteriography is essential. Proximal disease must be corrected first.

Angiography↗

PubMedDate not supplied

[Double-blind randomized comparative study of nicergoline naftidrofuryl on the quality of life in chronic obliterative arteriopathy of lower limbs with intermittent claudication].

The functional limitation of patients with obliterative arterial disease, and with intermittent claudication, damages their quality of life. The purpose of this trial was to compare the effects of nicergoline and naftidrofuryl on the quality of life and the functional discomfort of the 131 patients with claudication. It was a multicentre, randomised, double-blind trial with parallel groups. The patients were asked to complete a quality of life questionnaire and a Visual Analogue Scale, and to evaluate the number of steps on flat ground before the pain began. After 6 months of treatment, we observed, for all treatments combined, a significant improvement (p = 0.0001) in the quality of life and in the functional discomfort. Three variables favoured nicergoline: the estimated time before the onset of the pain (p = 0.003), the functional discomfort quantified by the Visual Analogue Scale (p < 0.05), the distance covered on flat ground (p = 0.013). The other variables, and especially the total score on the self-questionnaire, confirmed this impression, without reaching significance (p = 0.136). The data suggest that in terms of quality of life nicergoline is superior. The clinical tolerance is good and comparable between the two treatments.

Adult↗

PubMed1976

Prevalence of ischaemic heart disease, arterial hypertension and intermittent claudication, and distribution of risk factors among middle-aged men in Moscow and Berlin.

The initial examinations of prospective epidemiological studies of the same kind performed in random samples of 50-54 years old men from Moscow and Berlin showed the following prevalence rates (each first figure for Moscow, second for Berlin): ischaemic heart disease 14.4/13.6%, arterial hypertension 18.0/19.0%, intermittent claudication 6.9/3.4%, cigarette smoking 46.5/51.4%, overweight 22.9/21.9%, impaired glucose tolerance 36.6/42.5%. Hypercholesterolaemia (24.6/8.1%) was not comparable because different determination methods were used. In both population samples almost a half of IHD and 1/3-1/2 of hypertension cases were newly detected only by the study examinations. More than 80% of the 50-54 years old men showed the presence of one or more risk factors. The following significant relationships between disease groups and risk factors were found: for IHD, with hypertension, impaired glucose tolerance, and hypercholesterolaemia (Moscow only); for hypertension, with overweight, impaired glucose tolerance, and hypercholesterolaemia (Moscow only); for intermittent claudication, with cigarette smoking, impaired glucose tolerance, and hypercholesterolaemia (Moscow only). These comparative studies demonstrate the benefit and need of further common research and efforts for prevention and control of cardiovascular diseases.

Berlin↗

PubMed1997

[Consensus diagnosis and treatment of arterial intermittent claudication. Central Guidance Organization for Peer Review].

Intermittent claudication is an indicator of increased risk of cardiac and cerebrovascular morbidity and mortality and as such a reason to look for modifiable risk factors for atherosclerosis. A vascular anamnesis and physical examination can reliably exclude presence of peripheral arterial occlusive disease in the lower extremities, but cannot reliably demonstrate its presence. Certainty about presence or absence of peripheral arterial occlusive disease can be obtained by determination of an ankle-brachial blood pressure index. The main method for the diagnosis of severity and localisation of stenoses and occlusions in the arteries to the legs is the echo-Doppler (duplex) examination. With this method the feasibility of percutaneous transluminal angioplasty (PTA) can also be determined. Consequently, angiography has lost importance as a diagnostic method and is only still indicated as part of an interventional treatment (operation or PTA). Treatment should be aimed at both amelioration of symptoms and reduction of risk factors for atherosclerosis. A key-stone of the treatment is cessation of smoking. The role of pharmacotherapy in reducing symptomatology is only limited. Walking exercise can have a positive effect on walking distance and should always be tried. PTA is the treatment modality of first choice for stenoses in the aortoiliac and femoropopliteal arteries. For segmental occlusions in the iliac pathway, also recanalisation by means of PTA (in combination with stent placement) is a justifiable treatment option. In all other cases operative revascularisations give good functional results. Invasive treatments for patients with intermittent claudication should be performed within a multidisciplinary team.

Angiography↗

PubMed1998

Dorsal extradural lipoma as cause of spinal claudication. Case report and review of the literature.

Extradural spinal lipomas are rare tumorous lesions. "True adult lipomas" have to be histologically differentiated from angiolipomas. The authors describe a case of segmental dorsal lipomas in the lower lumbar spine which led to a clinical apparent spinal claudication. Having reviewed the literature this case is the first ever described. In this case MRI was the diagnostic tool of choice. The tumor could be removed completely via interarcual laminotomy and flavectomy. The clinical outcome was excellent. In differential diagnosis of a spinal claudication this rare cause should be kept in mind when typical osseous changes are absent.

Adult↗

PubMed2002

Severe potential consequences of delayed diagnosis in patients with hip claudication.

Delayed diagnosis in patients with hip claudication can lead to severe consequences. We report on patients with ischaemic hip claudication which had primarily been attributed to coxarthrosis. One patient went through a variety of treatments including hip arthroplasty. The second patient had a life-threatening abdominal aortic aneurysm (AAA) which remained undiagnosed. Orthopaedic surgeons should maintain a high degree of suspicion for vascular disease. Moreover, we strongly advocate that all men over 60 years old who seek medical advice for whatever reason should be screened once for AAA by ultrasonography.

Aortic Aneurysm, Abdominal↗

PubMed2001

Intermittent Claudication.

Intermittent claudication is the most common symptom in patients with peripheral arterial disease (PAD). As such, it is mandatory for clinicians to treat both the PAD-specific symptoms (to decrease functional impairment and thereby improve quality- of-life, as well as to decrease rates of amputation) and the underlying systemic atherosclerosis (and thereby reduce cardiovascular ischemic events, especially myocardial infarction and stroke). Most patients with claudication can successfully decrease their exertional limb symptoms via a combination of exercise (preferably supervised) and pharmacotherapeutic interventions (eg, cilostazol). Endovascular revascularization currently serves as an effective therapy for patients with high-grade stenoses of the proximal limb arterial segments, (eg, the distal aorta, common iliac artery, or external iliac artery, and occasionally the proximal common femoral artery). Surgical revascularization usually is reserved for patients who present with severe aortoiliac disease in whom long-term patency is likely to be achieved (eg, aortobifemoral or femoral-femoral bypass) and who have a low cardiovascular perioperative ischemic risk. Patients who undergo successful revascularization also are likely to benefit from exercise rehabilitation programs. All patients with PAD, of any severity, must successfully normalize atherosclerosis risk factors and use antiplatelet therapies. Such interventions include complete smoking cessation, glycemic control, normalization of blood pressure (less than 130/90 mm Hg), and lowering of low-density lipoprotein (LDL) cholesterol to less than 100 mg/dL. Antiplatelet agents (eg, clopidogrel, aspirin) should be prescribed to decrease rates of cardiovascular ischemic events in all patients with PAD, unless otherwise contraindicated.

Journal Article↗