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PubMedDate not supplied

[Does intermittent claudication justify surgical intervention].

The authors have re-examined their therapeutic attitude toward the intermittent claudication upon arteriopathy. They feel that it is useful to divide patients having an arteriopathy (Stage II) into two groups: the first having isolated (or dominant) high aorto-iliac lesions and the second with isolated or dominant lesions at the mid-femoral level. In the first group, we remained faithful to reconstructive surgery and our preference goes to thrombo-endarteriectomy with accompanying low lumbar sympathectomy. In femoral lesions, we do not recommend reconstructive surgery of the arteries but rather low lumbar sympathectomy. For the past year, we have undertaken a program of physical re-education and the results seem very encouraging, especially in patients having isolated femoral lesions. It is not impossible that this physical therapy may be used instead of lumbar sympathectomy, to which one can always resort in case of insufficient results.

Aged↗
PubMedDate not supplied

[Intermittent claudication. Synthesis and conclusions].

The intermittent claudication is a symptom. By itself, it does not justify surgical treatment. On the other hand, it is advisable when accompanied by a threat of trophic disorders. Direct arterial surgery is often necessary in the case of suprainguinal, aorto-iliac lesion, rarely in the leg. Indeed, under the inguinal area, nature tends to compensate for occlusions of the trunk by the formation of a parallel network. A logical treatment is to contribute to this tendency, by increasing the upward and downward pressure gradient through muscular exercise and lumbar sympathectomy. In practice, the choice between hyperemia surgery and reconstructive surgery rests on functional data, that make it possible to evaluate the potential of the parallel network and of the peripheral vascular bed.

Humans↗
PubMed1980

Intermittent claudication: a controlled study in parallel time of the short-term and long-term effects of cinnarizine.

In a group of 45 patients with mild to moderately severe claudication studied over the same 4-month period, cinnarizine administration (75 mg 3-times daily) was associated with a greater than 20% improvement in walking distance in 65% of the patients, who derived significantly more benefit than the 30% of placebo responders. The mean improvement in walking distance was 11% for the placebo group compared to 142% for cinnarizine-treated patients. An open 12-month follow-up showed that improvements in walking distance with cinnarizine were maintained in all 12 patients, whereas in the 10 control patients only 10% reported improvement. Objectively, significant plethysmographic improvements were detected only for the cinnarizine-treated patients and shown by an increase in arterial flow-pressure dynamics of the lower limbs.

Aged↗
PubMed1980

[Programmed physical training in physiotherapy for obliterative arteriopathies of the lower limbs at the stage of claudication (author's transl)].

Rehabilitation of lower limb arteriopathies at the stage of claudication is carried out during a stay of 30 to 45 days in a rehabilitation center. The daily program comprises general gymnastics, a specifical exercise training, and sport. The training is performed differently following the proximal, medial or distal level of arterial insufficiency. It includes sets or rythmical contractions up to about 70% of maximal capacity determined by a weekly test exercise.

Exercise Therapy↗
PubMed1980

[Objective evaluation of arterial intermittent claudication by the walking tolerance test. Comparative study of physiological walking and walking on a conveyor belt (author's transl)].

Two methods are used to evaluate the walking distance: physiological walking along a standard path (0% - 6 mk/h) and walking on a tread mill (10% - 3 km/h). In both tests, four data are checked: -- initial trouble distance, -- cramp or walking-distance, -- localisation of pain, -- recovery time. These tests are dependable for the diagnosis of arterial claudication, reproducible and well tolerated. Their results have been compared: there is no correlation between the initial trouble distance and the cramp distance. However there is a correlation between the cramp distance by physiological walking and on treadmill. Recovery time, if long, is a criteria of gravity. Interests of both methods are discussed.

Adult↗
PubMed1980

[The treatment of intermittent claudication by physical retraining of the non-hospitalised patient. Evaluation of effectiveness in a group of 40 patients (author's transl)].

The treatment of intermittent claudication by physical re-training of a patient with lower limb arteriopathy is not new (Alpert 1969, Cachovan 1976, Kindler 1965, Schoop 1964). It gives an effective improvement of walking distance and of physical performance capacity. Most programs used need the patient to be kept in an hospital and thus entail a significant social cost. We have set up a program for the retraining of patients that are not hospitalized and have checked the short and long term action achieved. The walking distance, the maximum performance in specifical exercises, the walking exercises on a tread mill, are studied during the clearance X133, the total leg blood flow before and after an arterial occlusive hyperhemic test is studied simultaneously.

Ambulatory Care↗
PubMed1978

[Sensory-motor intermittent claudication syndrome of the cauda equina. Etiopathogenetic study of 25 cases].

The twenty-five patients with the intermittent claudication syndrome of th cauda equina included 19 men and 6 women aged from 23 to 70 years. The results of operation were very good in 16 cases, with improvement in 6 others and failure in 3 cases. There are various mechanisms which can cause the stenosis. The authors stress the importance of congenital vertebral abnormalities and the presence of apophyseal appendices which, at the present time, have not been considered responsible.

Adult↗
PubMed1995

[The pathogenetic factors for neurogenic intermittent claudication caused by degenerative lumbar spinal stenosis].

The pathogenetic factors in 89 patients with typical neurogenic intermittent claudication caused by lumbar spinal stenosis were studied retrospectively. 75 patients had degenerative lumbar spinal stenosis, and 67 had unilateral nerve root canal stenosis. In most patients, the stenotic location was found at the entrance zone of nerve root canal (75/89), involving only a single level (60/89) mostly at L4.5. The pathogenetic factors for degenerative lumbar spinal stenosis were degenerative changes of lumbar disc only (55/89), and those for hypertrophy of facet joints (22/89), thickened ligamentum flavum (11/89), and spondylolis thesis (10/89). All patients were operated on: 57 of them had less invasive procedures. The excellent and good early follow-up results were noted in 73% of the patients (65/89). The authors emphasized that the surgical treatment of lumbar spinal stenosis should be as less invasive as possible rather than a tranditional extensive lumbar laminectomy.

Adult↗
PubMed1995

Simultaneous laser Doppler and transcutaneous oxygen tension measurements in claudicant patients.

Laser Doppler (LD) flux and transcutaneous oxygen tension (TcPO2) were measured in supine and sitting position at the dorsum of the foot with local skin temperature of 37 degrees C and 44 degrees C in 50 patients with stage IIb of chronic peripheral arterial occlusive disease (CPAOD) and in 30 healthy controls. The statistical analysis showed no significant differences between patients and controls in the supine and sitting position at 37 degrees C. A lower increase of LD- flux and TcPO2 could be noticed during hyperthermia and reactive hyperaemia in the patients group as well as a significant prolongation of oxygen (ORT) and flux reappearance time, of postocclusion time to peak flux and oxygen peak, of postocclusion time to half of peak flux and oxygen peak and of time to flux restoration at preocclusion levels (FTMAX) during reactive hyperaemia test. FTMAX and ORT allowed a clear separation between patients and controls and exhibited a high reproducibility. A regression analysis equation was derived with the most significant parameters indicating the presence and the severity of the disease. Moreover, the estimated time parameters of LD - flux and TcPO2 were correlated with the US - Doppler ankle systolic blood pressure indices and therefore with the impairment of the macrocirculation. In summary, we find that skin perfusion in patients with intermittent claudication is not different from normal subjects under basal conditions. However, maximal perfusion is reduced and the time to peak perfusion after a provocative stimulus is delayed.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Gas Monitoring, Transcutaneous↗
PubMed1994

[The efficacy of ticlid in treating intermittent claudication in atherosclerotic stenosis of the arteries of the lower extremities].

Serious affections of hemostasis were found in hemostatic examinations involving 67 intermittent claudication patients resistant to longterm vasodilative drugs. A 4-6-month course of tiklid (500 mg daily) induced a significant fall in platelet aggregation and an increase in the blood fibrinolytic activity, decreased foot chilliness, pain while walking. 73% of the patients could cover longer distances without pain complaints.

Adult↗
PubMed1994

The effect of exogenous phosphocreatine on maximal walking distance, blood rheology, platelet aggregation, and fibrinolysis in patients with intermittent claudication.

Thirty-seven men with angiography or ultrasound confirmed peripheral arterial occlusive disease were divided into two groups. Group 1 included 24 patients treated with one daily infusion of 10 g of phosphocreatine in 200 ml of solvent for 10 days. Group 2 included 13 patients who were given 0.9% NaCl in the same scheme. Groups were comparable in: duration of intermittent claudication, maximal walking distance, Ketle index, cholesterol, triglycerides, frequency of ischemic heart disease, hypertension, diabetes, smoking. Patients were examined 4 times: before starting, on second day, after treatment period, and 1 month after. Treadmill-test; ADP-, PAF-, 5-HT-induced platelet aggregation; D-dimer; PAI-1 activity; blood viscosity at high and low shear rate; hematocrit were performed. After treatment maximal walking distance significantly increased in patients of Group 1. Mechanisms of this effects include positive influence of phosphocreatine on platelet aggregation, blood rheology, coagulation and fibrinolytic systems.

Blood Flow Velocity↗
PubMed1994

[Cystic adventitial degeneration. A rare cause of intermittent claudication].

Cystic adventitial disease of the popliteal artery is an unusual condition of uncertain etiology in which a mucin-containing cyst forms in the wall of the popliteal artery and causes symptoms of intermittent claudication. The patient is typically a young non-smoking male, whose arteries otherwise are normal. Arteriography may show a smooth-walled narrowing or a non-specific complete occlusion, but may also be normal. Non-invasive imaging techniques may be helpful. We report two cases of cystic adventitial disease. Both were successfully operated on with resection of the diseased arterial segment and vein bypass interposition.

Adult↗
PubMed1976

[Combination of physiotherapeutic exercise therapy with bencyclane in intermittent claudication (author's transl)].

Earlier investigations had shown that an intensive physiotherapy program with 30 treatments in 6 weeks was the most rational therapy for intermittent claudication, but the question whether the therapeutic success could be improved by the addition of "vasoactive" substances remained open. For this reason, bencyclane was added to the basic physiotherapy in a double blind trial involving 109 ambulant patients. 91 or these were evaluated. The treatment group (n = 45) showed a greater increase in walking distance of 21.7% compared with the placebo group (n = 46). Also in the evaluation of the therapeutic success rate, the treatment group showed better results (84.4%) than the placebo group (71.7%). From this it can be concluded that the basic physiotherapy can be effectively supported with bencyclane.

Adult↗
PubMed1993

Laser Doppler flowmetry, transcutaneous oxygen pressure and thermal clearance in patients with vascular intermittent claudication.

In the present study, heat thermal clearance (HTC) was compared to laser Doppler flowmetry (LDF) and transcutaneous oxygen pressure (tcPO2), measured on the forefoot of 17 patients with vascular intermittent claudication and 10 controls in various positions at rest and after a treadmill exercise test. The mean ankle brachial systolic pressure ratio (ABSP) of the patients, measured using ultrasonic Doppler velocimetry, was 0.53 +/- 0.05. Their walking distance was 480 +/- 100 meters, the treadmill exercise being stopped as soon as pain sensation. No statistically significant difference was found between patients and controls for HTC, LDF, tc P02, forefoot and ankle skin temperatures. Statistically significant differences between patients and controls occurred in the sitting position for tcPO2, in standing position for HTC and after treadmill exercise for tcPO2 and LDF. When assuming the sitting position HTC did not vary significantly in patients and decreased in controls, LDF decreased and tcPO2 increased in both groups. After treadmill exercise, HTC in patients did not vary compared to supine values and HTC decreased in controls, tcPO2 remained unchanged in controls and decreased in patients, LDF increased in controls and decreased in patients. No significant correlations were found between the different techniques measured at rest in patients and controls. However in patients, after the treadmill test, LDF correlated with the walking distance (r = 0.667) and with ABSP (r = 0.641), HTC inversely correlated with the walking distance (r = -0.680) and ABSP (r = -0.577). Laser Doppler, tcPO2 and HTC are useful as tools to understand the alterations of cutaneous microcirculation of the lower limbs in patients with V.I.C.. However their results need to be interpreted with caution because these methods do not measure directly blood flow.

Adult↗
PubMed1995

Pentoxifylline and intermittent claudication: review of clinical trials and cost-effectiveness analyses.

Intermittent claudication (IC) is common in the elderly; the prevalence is approximately 6% in 50- to 60-year-old patients and 10-20% in those over the age of 70. Several risk factors, especially smoking, are associated with increased prevalence. Disease progression results in increasingly debilitating and costly surgical intervention for about 20% of patients. This report reviews findings from some of the clinical studies that demonstrated the efficacy of pentoxifylline, the only U.S.-approved medical therapy for IC. Findings from a recently published cost-effectiveness analysis are presented. IC is difficult to study clinically because pain is both variable and subjective. In two multicenter, randomized, placebo-controlled studies, carefully monitored treadmill testing showed that pentoxifylline-treated patients had significantly improved walking distances even in the presence of a placebo effect. The pentoxifylline effect was pronounced in patients from a clinical target population defined by low baseline resting pressure ratios (< or =0.8) and long disease duration ( > 1 year). To understand the social implications of these findings, treadmill distances were converted to comparable distances on flat ground. Improvements on pentoxifylline therapy translate to walking distances that enable greater daily function. This improvement has significant practical benefit to the quality of life of IC patients. Using Medicare expenditure data, it was found that pentoxifylline therapy reduced average hospital costs per patients by $1,173. Direct medical cost savings of $69 to $3,090 were suggested by sensitivity analyses. In analyses of practical aspects of walking distance as well as cost-effectiveness analyses, pentoxifylline appears to be a highly useful treatment for IC.

Clinical Trials as Topic↗
PubMed1996

[The effect of Ginkgo biloba extract in patients with intermittent claudication].

Eighteen patients with stable intermittent claudication were randomized in a double blind cross-over study comparing the effects of the Ginkgo biloba extract GB-8 at a dose of 120 mg o.d. with placebo. All patients were treated for three months with the active extract and three months with placebo. The effects of treatment on arterial insufficiency were quantified by measurements of systemic and peripheral systolic blood pressures, and pain-free and maximal walking distances on a tread-mill. Questionnaires based on visual analogue scales were used to quantify the severity of leg pain, impairment of concentration, and inability to remember. Short-term memory was objectively assessed. We did not find any significant changes in either peripheral blood pressures, walking distances or the severity of leg pain. Systemic blood pressure was reduced both by placebo and GB-8. The impairment of concentration and the inability to remember were both reduced, when comparing results during active treatment to placebo. Short-term memory did not change significantly. In conclusion, our study has shown that treatment with the Ginkgo biloba extract GB-8 improves some cognitive functions in elderly patients with moderate arterial insufficiency, whereas the extract did not change signs and symptoms of vascular disease in the patients.

Aged↗