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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↗
PubMed1983

The effect of withdrawal of beta-adrenergic blockade on intermittent claudication.

Twenty-eight patients with intermittent claudication were studied before and one month after withdrawal of treatment with beta-adrenergic blocking drugs for hypertension, coronary heart disease or both. Heart rate, blood pressure, ankle/arm systolic blood pressure ratio and ankle pulse volume recording (PVR) at rest and after treadmill exercise were recorded, as well as walking distance, time of recovery from subjective symptoms, restitution time of pressure ratio and PVR. A control group of 14 patients, whose beta-adrenergic blocking drugs were not withdrawn, was also included. The result can be summarized as showing that withdrawal of beta-blockade was not demonstrably advantageous in patients with intermittent claudication. Significant improvement was observed only during the first month of the trial, a change which was independent of withdrawal of beta-blockade. The relief of subjective symptoms after exercise occurred significantly faster after withdrawal of nonselective beta-blockade. Otherwise, there was no difference between nonselective and cardioselective beta-adrenergic blocking drugs.

Adrenergic beta-Antagonists↗
PubMed1995

Micro- and macrocirculatory, and biohumoral changes after a month of physical exercise in patients with intermittent claudication.

We studied 15 subjects with intermittent claudication, classed as stage II according to Leriche-Fontaine. The patients were subjected to laser Doppler flowmetry, strain gauge plethysmography, Doppler velocimetry, and blood sampling, in basal conditions and after one month of physical training. Symptom-free walking distance at the end of the training period showed a significant increase, while there was no major change in maximal walking distance or the Windsor index. Laser Doppler flowmetry showed no significant change in cutaneous blood flow at rest, after the month of physical training. On the other hand, strain gauge plethysmography showed a significant decrease in rest flow at the end of the training period, while peak flow of postischemic hyperemia did not change appreciably. Biohumoral evaluations showed a significant decrease of white blood cell count, triglycerides and uric acid. Platelet count, prothrombin time, aPTT and plasminogen were unchanged. On the other hand, we recorded a small, but significant, rise of fibrinogen. Our study confirmed the importance of scheduled physical activity in the patient with intermittent claudication, showing that clinical improvement is not accompanied by an increase in the circulatory reserve. The unchanged levels of plasminogen suggest that the fibrinolytic activity does not vary significantly after a course of physical exercise.

Aged↗
PubMed1989

Efficacy and safety of pentoxifylline in geriatric patients with intermittent claudication.

The effects of pentoxifylline on intermittent claudication were evaluated at a dose of 1200 mg/day in an open-label twelve-week study on geriatric patients with chronic occlusive arterial disease (COAD). Standardized treadmill testing and clinical signs and symptoms of COAD were followed up before and during drug administration. Twenty-four subjects with a mean age of 73.5 years, capable of walking between 20 and 200 meters on the treadmill, were entered into the trial; 22 participated for eight weeks and 19 completed the study in terms of treadmill walking distance measurements at 12 weeks. The mean walking distance for all patients was increased 111% over baseline at week 12. Thirteen subjects were considered drug responders (greater than or equal to 50% increase in treadmill walking distance) and 9 were considered nonresponders (less than 50% increase). Improvements in clinical signs and symptoms of COAD were noted. Decreases in elevated systemic systolic pressures (but not diastolic) were unexpectedly observed in many drug responders. Seven of 19 males reported sexual function improvements while receiving pentoxifylline. Fourteen (58%) of the 24 subjects reported mild side effects of dyspepsia, nausea, vomiting, dizziness, headache, or insomnia; no subjects were withdrawn from the study because of side effects. In summary, pentoxifylline improved function and symptoms in 13 of 22 geriatric patients with intermittent claudication; the drug was safe and well tolerated at the usual dosage in this geriatric patient population.

Aged↗
PubMed1997

Effect of alpha-tocopherol (vitamin E) and beta-carotene supplementation on the incidence of intermittent claudication in male smokers.

We examined the primary preventive effect of vitamin E (alpha-tocopherol) and beta-carotene supplementation on intermittent claudication. The subjects--participants in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study--were male smokers aged 50 to 69 years who were randomly assigned to receive 50 mg of alpha-tocopherol daily, 20 mg of beta-carotene daily, both, or placebo. At baseline, there were 26 289 men with no history or symptoms of intermittent claudication. The Rose questionnaire on intermittent claudication was administered annually to discover incident cases. We observed 2704 cases of first occurrence of typical intermittent claudication during a median follow-up time of 4.0 years. Compared with placebo, the adjusted relative risk for typical intermittent claudication among those who received alpha-tocopherol only was 1.11 (95% confidence interval, 1.00-1.24); among those who received alpha-tocopherol and beta-carotene, 1.02 (0.91-1.13); and among those who received beta-carotene only, 1.02 (0.92-1.14). When we compared the alpha-tocopherol-supplemented subjects with those who received no alpha-tocopherol, the adjusted relative risk for typical intermittent claudication was 1.05 (0.98-1.14), and for beta-carotene-supplemented subjects compared with those who did not receive beta-carotene, the relative risk was 0.96 (0.89-1.04). In conclusion, no primary preventive effect on intermittent claudication was observed among middle-aged male smokers who were supplemented with alpha-tocopherol, beta-carotene, or both.

Antioxidants↗
PubMed2004

Walking exercise in patients with intermittent claudication. Experience in routine clinical practice.

BACKGROUND: In patients with intermittent claudication, exercise in the form of walking is effective in reducing pain and maximising achievable walking distance. However, data are lacking on the implementation of walking exercise in these patients. AIMS: To explore the current behaviour and views of patients with intermittent claudication towards taking walking exercise. DESIGN OF STUDY: Postal questionnaire and focus group meetings. SETTING: Two academic general practice networks (Utrecht and Maastricht Universities) in The Netherlands. METHOD: Three hundred and seventy-five patients with intermittent claudication, selected from the files of general practitioners participating in two academic general practice networks, were sent a postal questionnaire; 216 (58%) were returned. Nine of these responders also attended a focus group meeting. RESULTS: Seventy per cent (151/216) of the patients reported having received advice about walking exercise. If specified, the advice given most often recommended walking in the local neighbourhood (56%, 84/151). Fifty-two per cent (113/216) of all patients actually performed walking exercise and only 32%of them received any kind of supervision. Among the barriers for taking walking exercise, 'comorbidity', 'lack of (specific) advice' and 'lack of supervision' were often mentioned. Among the stimuli to start and continue walking, 'following the doctor's advice', 'relief of complaints' and 'a better general condition' were often mentioned by patients. CONCLUSIONS: Walking exercise was not carried out by almost half of patients with intermittent claudication in this study. Lack of specific advice and supervision were found to be important barriers to taking walking exercise.

Adult↗
PubMed1995

Lipoprotein(a) distribution in a French Canadian population and its relation to intermittent claudication (the Québec Cardiovascular Study)

This study was undertaken to evaluate the distribution and the relation of lipoprotein(a) (Lp[a]) concentration with intermittent claudication in a cohort of men aged 35 to 64 years, randomly selected in 1974 and followed until 1990. In 1985, blood samples for a complete fasting lipid profile and Lp(a) were obtained in 2,424 men representing 62% of the living cohort. The diagnosis of intermittent claudication was made by trained nurses using a standardized questionnaire and confirmed by a cardiologist. Lp(a) distribution did not change with age and was similar to that of other Caucasian populations. Because Lp(a) concentration did not vary with age, its relation to the incidence of intermittent claudication was assessed for the years 1974 to 1990. The incidence of intermittent claudication was 42 of 10,000 person-years. The 113 men with intermittent claudication, in contrast to men without this symptomatology, were older at entry (49 +/- 7 vs 45 +/- 7 years), and had higher systolic pressure (144 +/- 20 vs 136 +/- 16 mmHg) and Lp(a) levels (46 +/- 45 vs 33 +/- 35 mg/dl) (all p < 0.05). There was also a significantly greater prevalence of smoking and diabetes among men with intermittent claudication. The risk of intermittent claudication was doubled in men in the second and third tertiles of Lp(a) concentration (p < 0.001). Thus, high Lp(a) levels constitute a significant risk for intermittent claudication in this population.

Adult↗
PubMed2000

Pharmacological management of intermittent claudication: a meta-analysis of randomised trials.

Intermittent claudication, a symptom of atherosclerosis in the large vessels of the lower limbs, greatly affects patient mobility and quality of life. Medical therapy for a moderate form of this condition includes vasodilators, antiplatelet agents and alternative treatments such as ginkgo biloba.A meta-analysis of results from 52 trials (including 5088 patients) was conducted for all current medical therapies for intermittent claudication. After 24 weeks, some of the medical therapies were found to be more effective than placebo for the primary end-points of either pain-free walking distance or maximum walking distance. Vasodilators presented the best results in walking distance. Pentoxifylline offered better results than naftidrofuryl, although the treatment benefit, measured in additional metres walked with treatment than without, was modest. Antiplatelets, ginkgo biloba and levocarnitine were slightly more effective than placebo, although the treatment benefit was of limited clinical importance. On average, patients walked 60m further with therapy than without, and only about half of that added distance was pain-free. Very little consistent information was available for other clinical end-points, such as overall mortality and adverse effects. These data suggest that some of the medical therapy, pentoxifylline in particular, can only modestly increase functional status in patients with moderate intermittent claudication. There is a need for uniformity in research design and reporting of trials. A future trial comparing medical therapy with physical therapy is indicated.

Humans↗
PubMed1988

Intermittent claudication: predictors and outcome.

The authors reviewed 460 patients with intermittent claudication. With primarily conservative management, these patients were followed for an average of 4.1 years (one to ten years). The mean age was 71.7 years, ranging from thirty-six to eighty-four years; 55.9% were males. The subsequent follow-up study revealed that the status of 44.1% of the patients with underlying arterial insufficiency deteriorated. Eventually, they underwent vascular surgery for limb-threatening ischemia. From this study, the analysis of the parameters could predict the clinical outcome of intermittent claudication at the time of initial and follow-up evaluation. During initial evaluation, when the ankle brachial index (ABI) was higher than 0.7 or when follow-up evaluation did not show a decrease of ABI by 0.15, the chance of favorable outcome was increased by 2.4 and 1.6 times respectively. When the ABI was less than 0.5 at the initial evaluation and decreased 0.15 or more during follow-up studies, the risk of requiring vascular surgery for limb salvage increased by 3.8 and 1.9 times, respectively. The onset of major vascular events in other areas appeared to influence the time of significant deterioration in the lower limb arterial disease, indicating multifactorial and systemic contribution in the natural history of intermittent claudication. In this homogeneous patient population with arterial insufficiency referred to the vascular surgeon, conservative management with strong supervision for smoking cessation, exercise, diet control, body weight reduction, and medical regimen can modify the natural course of intermittent claudication and associated vascular problems.

Adult↗
PubMed2002

Comparison of the long-term results between surgical and conservative treatment in patients with intermittent claudication.

BACKGROUND: The optional therapeutic strategy for patients with intermittent claudication remains controversial. In this study, we investigated the influence of surgical and conservative therapies on improving the quality of life in patients with intermittent claudication. METHODS: We analyzed 427 patients who were admitted to our hospital with intermittent claudication in their legs during a 15-year period from January 1984 to December 1999. We separated them into 2 groups; 259 patients (362 legs) were treated surgically and 168 patients were treated conservatively. RESULTS: At the suprainguinal and infrainguinal (above knee) region, the surgery group showed significantly better rate of improvement than did the conservative group, but in the infrainguinal (below knee) region, there was no significant difference between the 2 groups. The 3-year and 5-year patency rates for the arterial reconstruction of the suprainguinal and infrainguinal region was satisfactory, but that of the infrainguinal region was not very good even if an auto vein graft was used. CONCLUSIONS: Aggressive surgical treatment is therefore recommended in patients whose distal anastomotic region is above the knee, because there are great benefits from surgical reconstruction. However, in patients whose distal anastomotic region is below the knee, conservative treatment might be just as effective as surgery.

Aged↗
PubMedDate not supplied

Management of peripheral arterial disease and intermittent claudication.

BACKGROUND: Peripheral arterial disease (PAD) is the chronic obstruction of the arteries supplying the lower extremities. The most common symptom is intermittent claudication resulting in aching pain, numbness, weakness, or fatigue in the muscle groups of the lower extremities. METHODS: Using the key words "peripheral arterial disease," "intermittent claudication," "atherosclerosis," and "cardiovascular disease," MEDLINE databases were searched from 1970 to the present. The most recent articles pertinent to current treatment recommendations for PAD and intermittent claudication were selected to document this review. RESULTS AND CONCLUSIONS: Symptoms of intermittent claudication are induced by walking or exercise and usually resolve with rest. Disease severity varies from patients who are asymptomatic to those who have unremitting symptoms. A high overlap exists between PAD and coronary artery and cerebrovascular disease. Risks for long-term morbidity and mortality are identical for PAD, intermittent claudication, and coronary artery disease. Treatment of PAD is aimed at maintaining or improving functional status, reducing or eliminating ischemic symptoms, and preventing disease progression. Exercise and aggressive risk factor modification represent the cornerstones of treatment. Risk factors include smoking, diabetes, lipid abnormalities, hypertension, C-reactive protein, lipoprotein(a), and hyperhomocystinemia. Antiplatelet and lipid-altering therapies decrease risk of atherosclerotic vascular complications and are being studied to improve intermittent claudication. Cilostazol, a new antiplatelet, antithrombotic agent, reduces claudication symptoms. Angiogenic growth factors have shown preliminary success in patients with rest pain and ischemic ulcers and are being investigated for use in patients with intermittent claudication. Invasive revascularization procedures can be considered for patients with critical limb ischemia or when medical therapy fails.

Arteries↗
PubMed1992

[Regulation of blood circulation in the extremities in intermittent claudication].

UNLABELLED: The study was aimed to investigate the characteristics of the limb circulation in patients suffering from intermittent claudication. The study group consisted of 71 patients with intermittent claudication. As control served the data of 60 patients with intact peripheral circulation and 24 patients suffering from rest pain, too. The limb blood flow was measured by the venous isotope dye-dilution method. RESULTS: 1. The limb blood flow will be diminished in intermittent claudication already in resting state. The decrease of the limb blood flow is more expressed in severe claudication (with short claudication distance). 2. The pathological condition of the limb circulation in intermittent claudication can be characterized by the elevation of the limb vascular resistance. 3. The O2 consumption of the limb tissues will decrease in intermittent claudication. The data of the study are indicating that the regulation of the limb circulation will pathologically be changed in claudication. The reserves of the peripheral circulation are diminished and the insufficiency of the limb circulation will be manifested on walking.

Adult↗