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PubMed1981

Isolated profunda femoris artery occlusion: the mechanism of thigh claudication studied by 99mTc muscle clearance from the thigh and calf.

99mTc muscle clearance from the gastrocnemius and quadriceps and ankle pressure measurements have been studied in 5 limbs of 5 patients with an isolated profunda femoris artery occlusion shown on the aortogram. The changes of flow and pressure which occurred after exercise may explain the hemodynamics of thigh claudication which is the consequence of thigh deprivation in favour of calf flow.

Adult↗
PubMed1984

Effects of flunarizine and pentoxifylline on walking distance and blood rheology in claudication.

Thirty-one patients, mean age 60 years (range 45-80 years), with a typical history and objective symptoms of intermittent claudication with a reported maximal walking distance less than 500 m, were included in a cross-over study. After a one month's run-in period on placebo, the patients were randomized into two groups: one group started with flunarizine (5 mg t.i.d.) and the other with pentoxifylline (400 mg t.i.d.). The treatment lasted 3 months, whereafter the medications were changed. The trial followed a double-blind design. The median of the maximal walking distance was 255 m after the placebo period, increasing significantly (p less than 0.01) during both medication periods: by 43% and 18% during flunarizine and pentoxifylline, respectively. No changes were recorded in the ankle systolic blood pressure ratio ( ASBP -ratio) after placebo or either medication period. Red cell rigidity (Pmax), which was initially elevated, decreased significantly (p less than 0.05) during both medication periods, but there were no significant differences between the two drugs. No changes were found in whole blood or plasma viscosity. We conclude that the decrease in red cell rigidity may have contributed to the increased walking distance.

Aged↗
PubMed1984

Pharmacology of pentoxifylline, a hemorheologic agent for the treatment of intermittent claudication.

Physiological and pathophysiological aspects of systemic and cardiac haemodynamics are reviewed with appraisal of Carl J. Wiggers merits and contributions to the research and developments in this field and his early recognition of the significance of the flow properties of blood in impaired circulation. Pharmacological agents involved in treatment of peripheral vascular diseases are discussed with special regard to the haemorheologically active xanthine derivative pentoxifylline. The profile of pentoxifylline as it emerges from experimental pharmacological and clinical studies is presented paying special attention to the haemorheological properties of the drug. Pharmacokinetic features of pentoxifylline are surveyed touching absorption, blood levels, metabolism and excretion aspects. Basing on the available data pentoxifylline is regarded as a promising drug in the treatment of circulatory ischemic disorders, especially in intermittent claudication.

Absorption↗
PubMed1984

The effectiveness of isoxsuprine in patients with intermittent claudication.

Sixty male patients with intermittent claudication were investigated in a randomized, double-blind, placebo-controlled study in order to determine the effectiveness of Isoxsuprine. The analysis of the results was made on the basis of subjective assessment of symptoms by the patients themselves and also on the results of segmental blood-pressure measurements and ankle/arm indices at rest and after standardised exercise. Significant differences were demonstrated between the active and placebo groups as regards pain-free walking distance although arterial pressure measurements did not show statistically significant differences between the two groups. Isoxsuprine appears to be significantly beneficial only for patients with obstructions at the femoro-popliteal level.

Adult↗
PubMed1984

Leg blood flow in intermittent claudication--a comparison between non insulin dependent diabetics and non diabetics.

The influence of diabetes on leg blood flow in intermittent claudication has been assessed by comparing the systolic arm-ankle pressure gradient at rest and resistance to blood flow during reactive hyperemia in patients with non-insulin dependent diabetes and non-diabetic controls. Cases and controls were matched for age and sex. Smoking habits, blood pressure, and blood lipids didn't differ in the two groups. Diabetes was associated with a higher resistance to blood flow during reactive hyperemia and a greater arm-ankle pressure gradient at rest. Resistance to blood flow during reactive hyperemia was in the non-diabetics strongly correlated to the arm-ankle pressure gradient at rest (r = 0.84). Corresponding correlation coefficient was in diabetics 0.04. In one of four diabetic legs a high resistance to blood flow during reactive hyperemia didn't correspond to a big arm-ankle pressure gradient. The results in this study support the concept of both macro- and microvascular disease in diabetes.

Adolescent↗
PubMed1985

Mortality and morbidity in patients with intermittent claudication in relation to the location of the occlusive atherosclerosis in the leg.

Mortality and morbidity from cerebrovascular and coronary arterial disease over a period of six years were studied in 224 non-diabetic patients with intermittent claudication. Patients with multiple arterial stenoses in the leg had a lower six-year survival than patients with single stenoses (55% versus 77%), with a higher mortality from cardiac deaths. These differences were still significant after adjustment for differences in clinical characteristics at the initial examination. This might indicate that patients with multiple arterial stenoses in the legs have a more widespread and more progressive atherosclerotic disease.

Aged↗
PubMed1986

The effect of beta-blockade on leg blood flow in hypertensive patients with intermittent claudication.

The present study was designed to assess the short-term effects of beta-blocking antihypertensive treatment on leg blood flow in patients with peripheral artery disease. Seven patients with intermittent claudication were randomly allocated to treatment with atenolol 100 mg or pindolol 10 mg. Patients switched therapy after one month of treatment. Venous occlusion plethysmography on the calves was used to assess the effects on leg blood flow after one and two months of treatment. The average 10% reduction of the systolic and diastolic blood pressures was not associated with any reduction of blood flow at rest. There was on average 3.4 ml reduction of peak flow which had no influence on the painfree or total walking distance.

Adult↗
PubMed1986

Plasma beta-thromboglobulin levels and claudication degrees in patients with peripheral vascular disease.

In 30 patients with varying degrees of claudication and 40 normal subjects, plasma levels of beta-thromboglobulin were determined. These were significantly higher (p less than 0.01) in the patients than in age-matched controls; in the control group the beta-thromboglobulin values resulted slightly higher in older subjects. No correlation was found between beta-thromboglobulin and the severity of the vascular disease, assessed on the basis of the pain-free interval on the treadmill.

Adult↗
PubMed1987

The oral glucose tolerance test in men under 55 years of age with intermittent claudication.

Blood glucose at sixty, ninety, and one hundred twenty minutes after a standardized oral glucose load was compared in healthy middle-aged men and patients with intermittent claudication. No difference was found when the authors compared blood glucose at zero and sixty minutes. At both ninety and one hundred twenty minutes, however, they found a relative hypoglycemia in patients with peripheral arteriosclerotic disease in an early stage.

Administration, Oral↗
PubMed1987

Lower extremity blood flow in intermittent claudication--the role of oral glucose tolerance test.

Tobacco smoking is a risk factor for peripheral arterial disease. During oral glucose tolerance tests (OGTT) in a population study the author and co-workers have earlier shown that smokers have higher blood glucose values early postload and lower values at two hours compared with nonsmokers. Eighty-three patients, all with intermittent claudication but with a normal OGTT, have now been studied according to their response to an oral glucose load. The blood flow resistance during reactive hyperemia, as measured with a calf plethysmograph, was compared between subjects in the quartile of patients with the highest forty-five-minute blood glucose and those in the lowest quartile. The blood flow resistance was significantly higher in the group with a high forty-five-minute blood glucose, 13.3 +/- 1.34 vs 9.5 +/- 0.65 (mean +/- SEM), p less than 0.02. Blood pressure and blood lipids were similar in the two groups. It is suggested that an exaggerated early response in the OGTT might be an independent risk factor for peripheral arterial disease.

Blood Glucose↗
PubMed1988

Improvement of walking distance in patients with intermittent claudication by chronic local therapy with isosorbide dinitrate ointment.

Isosorbide dinitrate ointment (100 mg tid) was directly applied to 30 male patients with stable, documented intermittent claudication on the areas where ischemic pain was experienced. The symptom-free distance walked (DWA) and the maximum distance reached (MDR) basally, after one, three, six, and twelve months were evaluated by means of treadmill stress tests (TSTs) (angle 0 degree-velocity constant/patient). After the basal TST, patients were randomly divided into two groups: placebo group and therapy group (double blind), and a further TST was administered one month later. DWA results were 74 +/- 8 m vs 297 +/- 83 m and MDR results were 163 +/- 22 m vs 506 +/- 86 m in the therapy group (basal vs one month TST: p less than .01) and 94 +/- 24 m vs 96 +/- 15 m and 232 +/- 53 m vs 183 +/- 26 m in the placebo group, respectively (basal vs one month TST: NS). Being confident that a significant placebo effect was absent, the authors opened the trial and treated all patients, repeating further TSTs at three, six, and twelve months. The following results were obtained: DWA was 84 +/- 13 m, 316 +/- 63 m, 374 +/- 55 m, and 452 +/- 61 m; and MDR was 197 +/- 29 m, 431 +/- 59 m, 514 +/- 57 m, and 547 +/- 59 m, respectively, in basal conditions and after three, six, and twelve months of treatment (p less than .01 for all the values for both DWA and MDR vs basal values).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical↗
PubMed1988

Effects of naftidrofuryl in patients with intermittent claudication.

In a randomized, double-blind, placebo-controlled study in patients with peripheral arterial occlusive disease stage IIb of Fontaine's classification, the efficacy of naftidrofuryl, a vasoactive substance, was investigated. Forty patients--31 men and 9 women with an average age of 62.98 +/- 10.65 years--were admitted to the study. All had a history of claudication for at least six months. The duration of the trial was eighteen weeks. After a washout period of two weeks the patients received either two times 400 mg naftidrofuryl or two identical placebo tablets daily for eight weeks. Subsequently a crossover from verum to placebo and vice versa was carried out and the alternative medication was administered for another eight weeks. Clinical results were evaluated by measuring painfree and maximal walking distance by treadmill test at a speed of 3.2 km/h and an inclination of 12 degrees. Systolic ankle pressure and brachial pressure were measured by Doppler ultrasound, and ankle/arm pressure ratio was calculated. Treadmill test, Doppler ultrasound examination, and laboratory data analysis were performed at the beginning of every study period, every four weeks during and at the end of the study. Results. The patients in both groups showed an initial homogeneity of age, risk factors, concomitant diseases, walking distance, and Doppler indices. After eight weeks naftidrofuryl resulted in a statistically significant increase in painfree (p less than 0.02) and maximal walking distance (p less than 0.05). The placebo-treated group showed only a slight, statistically nonsignificant increase in both painfree and maximal walking distance.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1990

Placebo-controlled, double-blind study of the effect of verapamil in intermittent claudication.

The clinical effect of verapamil was tested in 24 patients with intermittent claudication in a randomized, placebo-controlled, double-blind, crossover study. Slow-release verapamil or placebo was given for two periods of three weeks. The walking distance, systemic blood pressure, and ankle-brachial blood pressure index were measured. Furthermore, a possible change in peripheral vascular tone was provoked by hyperventilation. The walking distance rose after both verapamil (40%) and placebo (31%) (p less than 0.01 for both) but tended to increase only after verapamil (7%) as compared with placebo. Blood pressure fell equally after both verapamil and placebo (p less than 0.05 for both). Verapamil did not influence the ankle-branchial blood pressure index. No signs of vasoactivity in the lower extremities were seen after hyperventilation. Although the greatest individual improvements in walking distance were seen after verapamil administration, it was not possible to predict positive responders among the patients.

Adult↗
PubMed1991

Efficacy of low-molecular-weight heparin in the management of intermittent claudication.

Treating chronic arterial occlusive disease with heparin is controversial because of the risks associated with long-term anticoagulant therapy. Low molecular weight (LMW) heparin (mw about 5000 Dalton), which selectively inhibits the Xa factor with minimal risk of hemorrhage, seems to offer new possibilities in the prevention and treatment of both venous and acute arterial thromboembolism. Therefore, 44 patients with intermittent claudication were recruited to a randomized, double-blind, controlled study. Twenty-two were treated for six months with a single daily subcutaneous dose (15,000 UaXa) of LMW heparin and 22 with placebo administered in the same way over the same period of time. After six months, LMW heparin treatment not only improved walking capacity (by lengthening the pain-free walking time by 25%) but also significantly modified the hemorrheologic pattern (by reducing fibrinogen concentrations and whole blood viscosity at low shear rates). LMW heparin also exerted an antithrombotic and profibrinolytic effect by significantly increasing both the anti-Xa factor and plasminogen activity without markedly modifying activated partial thromboplastin time (+20%). No LMW heparin-treated patient hemorrhaged or reported other noteworthy side effects. These results suggest LMW heparin might be a useful drug in the long-term treatment of chronic arterial occlusive disease of the limbs.

Aged↗
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↗
PubMed1993

Blood viscosity during long-term treatment with ticlopidine in patients with intermittent claudication. A double-blind study.

The aim was to test within a randomized, double-blind trial whether the antiaggregant drug ticlopidine might reduce blood viscosity as has been claimed. Sixteen patients with intermittent claudication were studied before and after three years of treatment with ticlopidine, 500 mg/day, or placebo. At baseline, the viscosity values were significantly higher as compared with a reference group of healthy subjects. Whole-blood viscosity, measured at four different shear rates at hematocrit adjusted to a standard 40%, decreased significantly at follow-up, with no difference between ticlopidine treatment and placebo. Hematocrit showed a slight increase in the placebo group. The viscosity parameters were unrelated to lower limb blood flow variables, ankle/brachial index, and walking distances. The mechanism behind the overall decrease in whole-blood viscosity is obscure but could possibly be explained by lifestyle changes. Smoking habits were, however, unaltered. Since plasma viscosity remained increased, it might indicate that some erythrocyte factor, notably red cell aggregability and deformability, had improved. It is concluded that ticlopidine had no long-term effect on blood viscosity.

Aged↗
PubMed1993

99Tcm-sestamibi uptake in the leg muscles and in the myocardium in patients with intermittent claudication.

99Tcm-Sestamibi has now replaced 201Tl as a cardiac imaging agent. In addition to the myocardial uptake there is also a considerable uptake in the striated muscle, which may be used for analyzing the muscular perfusion. Sixteen patients with intermittent claudication were investigated with 99Tcm-Sestamibi-SPECT (single photon emission computerized tomography) in order to visualize coronary ischemic disease. After the registration of the myocardial perfusion they were also studied regarding their leg muscle perfusion. This was done at rest and during standardized stress test using a bicycle ergometer. In 10 of the patients there was an increase in the isotope uptake in the myocardium from work to rest > 10% reflecting pronounced myocardial ischemia, which, however, was symptomatic in only 4 of the patients. The muscular uptake in the myocardium of 99Tcm-Sestamibi in the thigh increased significantly from rest to exercise (P < 0.01), while it remained unchanged in the calf muscle. There were no significant correlations at rest between the ratio of the right and left systolic blood pressure in the ankles and the ratio between the right and left isotope uptake in the calves, but the increase in the isotope uptake from rest to work correlated with the blood pressure ratio at r = 0.79, P < 0.01 (anterior projection) and r = 0.71, P < 0.01 (posterior projection).

Adult↗
PubMed1997

Effects of indobufen and pentoxifylline on walking capacity and hemostasis in patients with intermittent claudication: results of six months of treatment.

Seventy-one patients with peripheral arterial occlusive disease (PAOD) were randomized into two groups of different treatment modalities. The diagnosis of PAOD was established by history of intermittent claudication, clinical examination, and by Doppler pressure assessment or lower extremity arteriography. After a three-month washout period, 35 patients (Group 1) started treatment with indobufen (400 mg per day) and 36 patients (Group 2) with pentoxifylline (600 mg per day). Twenty-nine patients from each group completed six months of treatment. Both of the drugs significantly improved maximal and pain-free walking distances, but the effect of indobufen was more pronounced than that of pentoxifylline. Patients with PAOD exhibited signs of hypercoagulation. Fibrinogen, D-dimer, and b-thromboglobulin concentrations did not change significantly following treatment in both of the groups. The authors observed a decrease of platelet aggregation after treatment with indobufen and a decrease of F1 + 2 fragment and PAI-1 antigen after treatment with pentoxifylline.

Fibrinogen↗