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PubMed1996

[Load tests in silent myocardial ischemia and latent heart failure in patients with IHD and intermittent claudication].

244 patients with ischemia of the lower limbs were treated surgically in the specialized cardiovascular center. No lethal outcomes were reported because previously derived algorithm of detecting silent myocardial ischemia in patients with intermittent claudication and load tests (bicycle ergometry and drug stress tests) had allowed the surgeons to ascertain the extent of coronary damage and detect subclinical cardiac failure. Valid assessment of cardiac factors enabled the right choice between surgical and therapeutic methods and staging of the procedures.

Arteriosclerosis↗
PubMed1996

Effects of captopril and ticlopidine, alone or in combination, in hypertensive patients with intermittent claudication.

Twenty four male hypertensive patients suffering also from peripheral obstructive arterial disease were randomly subdivided in two groups and after a period of farmacological wash-out of one month Group I was treated with Captopril (C 50 mg bid) or Ticlopidine (T 250 mg bid) for three months and then with the association C plus T for three months again. After placebo administration for one month, patients were further treated with C plus T at low doses (25 mg bid and respectively 250 mg daily). In the first part of the study, patients of Group II received an inverse sequence of the drugs (before Ticlopidine 250 mg bid and then Captopril 50 bid). In both groups of patients C induced a significant decrease of blood pressure and an increase of PFWD, TWD, and WI. T did not modify blood pressure but slightly increased PFWD, TWD, and WI. The improvement was more evident during administration of C plus T, whereas placebo administration induced a trend toward baseline values. Finally, the chronic administration of C plus T for twelve months induced a further improvement of all considered parameters. In conclusion, chronic administration of C plus T may be useful in the treatment of hypertensive patients suffering from intermittent claudication, improving significantly PFWD and TWD.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1996

Metal excretion and magnesium retention in patients with intermittent claudication treated with intravenous disodium EDTA.

Sixty patients with intermittent claudication participated in a double-blind placebo-controlled trial of 20 courses of intravenous chelation therapy with 3 g of disodium EDTA vs placebo during 5-9 weeks. After the first infusion, the 24-h urinary excretion of lead and zinc was approximately 25-fold higher in the EDTA-treated group; relative differences for copper and calcium were smaller. Urinary magnesium excretion in the EDTA-treated group was one-third less than in the control group. After the treatment period, the blood lead concentration had decreased by approximately 73% and the serum zinc concentration by approximately 34%; other changes in blood concentrations were negligible. The loss of essential minerals and the possible redistribution of lead in the body may constitute a disadvantage that should be taken into account in repeated intravenous EDTA treatment.

Adult↗
PubMed1997

Success of an outpatient claudication group training program for patients with peripheral arterial occlusive disease (PAOD): the Tübingen model.

Active exercise therapy plays a decisive role in the prognosis for early forms of peripheral arterial occlusive disease (stages I and II). We present a model project for an outpatient claudication group which has proved successful in the active exercise therapy of early forms of arterial occlusive disease (PAOD). In addition to the training principles familiar from intensified, performance-keyed walking programs, a newly developed pedal ergometer was employed which makes controlled endurance training possible for this patient group. The distance patients were able to walk without pain increased significantly in 17 out of the 26 patients taking part in the program. This clinical success was confirmed by an examination of arterial hemodynamics. The transformation of a theoretical concept into a functioning training program and the positive results achieved with it should encourage others to establish similar programs close to the patients' homes.

Adult↗
PubMed1997

Effects of intravenous lipoprostaglandin E1 on neurogenic intermittent claudication.

Circulation disturbances in the cauda equina and nerve roots have been implicated in the genesis of neurogenic intermittent claudication (NIC) in patients with lumbar spinal stenosis (LSS). We report the clinical results of lipoprostaglandin E1 (lipo-PGE1) treatments in patients with NIC. Lipo-PGE1 was administered intravenously for 10 consecutive days to 40 patients, 31 of whom showed a response to the treatment. Of the clinical symptoms examined, walking ability and leg numbness were significantly improved with an average effective period of 2.5 months. However, patients with radicular pain and severely affected patients did not respond well. Nerve root circulation in eight patients who subsequently underwent surgery was measured with a laser Doppler flowmeter. We observed increased blood flow in seven of these eight patients, after the intraoperative administration of lipo-PGE1. Lipo-PGE1 produced symptomatic improvement for a limited period in the treatment of NIC associated with LSS. The drug appeared to exert its effects through an increase in the circulation of blood in the nerve roots and the cauda equina.

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↗
PubMed1998

[A 56-year-old man with abdominal pain, intermittent claudication and a retroperitoneal mass].

OBJECTIVE: To describe an additional case of idiopathic retroperitoneal fibrosis. METHODS/RESULTS: A 56-year-old man consulted for abdominal pain and previous symptoms of intermittent claudication. A CT scan disclosed a retroperitoneal mass, for which reason the patient was submitted to surgery. Analysis of the biopsy specimen demonstrated retroperitoneal fibrosis. CONCLUSION: Although the clinical diagnosis of this disease is usually based on the CT findings, a histological analysis of the biopsy specimen provides a definitive diagnosis and permits intraperitonization of the ureters, which is the widely accepted treatment, during the same surgical session.

Abdominal Pain↗
PubMedDate not supplied

Continuous electrocardiography recording at examination of walking capacity in patients with intermittent claudication.

A treadmill test with increasing "walk-work" load and continuous electrocardiographic monitoring has been used in 245 patients with intermittent claudication. It was found that many patients underestimated their walking capacity. No good correlation was obtained between the observed walking capacity and the systolic blood pressure in the toes. Pathological electrocardiograms were found at rest in 36 per cent of the patients. Additional pathological ecg-reactions indicative for ischaemic heart disease appeared during the tests in 34 percent of the patients. Around 10 per cent of the tests had to be interrupted because of threatening ecg changes.

Aged↗
PubMed1998

Methods for studying leukocyte filterability in undiluted blood from intermittent claudicants.

Leukocytes are characterised from their influence on the filterability of undiluted blood from patients with PAOD (intermittent claudicants - Fontaine Stage II) and a group of sex and age-matched controls. Undiluted blood was filtered through 5 microm Nuclepore (Hemafil) filters for 300 s, at 711 Pa and room temperature, using a custom-made constant pressure filtrometer. Four populations of leukocytes are identified in both groups. In the control group, 94.4% of the leukocytes are identified as fast leukocytes with a transit time of 1.8 s. The remaining white cells are recognised as slow flowing leukocytes and subdivided into three further sub-populations. The first of these (SL1; 2.8% of total leukocyte count) is characterised by a transit time of 31.7 s, a second population (SL2; 1.5% of total leukocyte count) by a transit time of 145.8 s while the remaining cells are identified as pore blockers (PB) under these conditions. A similar rheological classification is valid in the patients but the sum of the three minor populations is elevated compared to controls (p = 0.001) although there is no overall leukocytosis. The only significant difference in flow properties of any blood cells, between the two groups of volunteers, is seen in the major population of leukocytes with an elevated transit time of 2.4 s. Stepwise regression analysis identifies the concentration of fast leukocytes, SL2 and PB as the major variables affecting blood flow through the filter. It is argued that the higher concentration of SL2 and PB probably reflect the increased sensitivity of neutrophils to physical stimuli.

Aged↗
PubMed2006

Claudication secondary to Perclose use after percutaneous procedures.

The use of suture-mediated arterial closure devices has dramatically increased with the increased number of percutaneous procedures being performed. Complications from suture-mediated closure devices have been underreported. Specifically, arterial stenosis resulting in claudication has not been previously described in detail. We present nine patients who presented with various leg symptoms after Perclose was used to achieve arterial hemostasis following percutaneous procedures. All cases were found to have significant arterial stenoses from the Perclose sutures. Once diagnosis was correctly made, the patients either underwent surgical repair or percutaneous balloon angioplasty and in all cases the symptoms abated.

Adult↗
PubMedDate not supplied

Claudication on mastication following bilateral external carotid ligation.

Ligation of both external carotid arteries to control epistaxis can produce a decrease in the blood supply of the muscles of mastication sufficient to cause pain typical of claudication while chewing. We report 3 cases of this complication. We advocate that this procedure be used only in special circumstances.

Adult↗
PubMed1985

Priapism as a feature of claudication of the cauda equina.

A case is reported of a man 60 years of age with degenerative stenosis of the lumbar canal at the L3-4 level and lumbar arachnoiditis, whose symptoms of claudication of the cauda equina were accompanied by uncomfortable involuntary erections. All symptoms were relieved by surgical decompression.

Arachnoiditis↗
PubMed1995

Percutaneous transluminal angioplasty in femoral artery occlusions: primary and long-term results in 107 claudicant patients using femoral and popliteal catheterization techniques.

To assess the impact of percutaneous transluminal angioplasty (PTA) of occluded femoral arteries, a prospective study of 107 claudicant patients was performed. A total of 117 limbs were treated and were followed for 1-36 months; the mean length of treated occlusions was 7.4 cm (range 2-25 cm). Eighty-nine recanalizations were performed using antegrade femoral and 28 using the retrograde popliteal catheterization technique. With logistic regression a short length of occlusion correlated favourably with early success. Including rePTAs and applying standardized criteria, survival analysis with the Kaplan-Meier method revealed a 3-year secondary patency rate of 55% for all the treated limbs. The following factors had negative influence on primary patency after successful recanalization; presence of soft thrombotic material in the recanalized artery segment and the presence of focal dissections after PTA. In univariate and multiple logistic regression analysis, male gender and a lesser extent of the atherosclerotic disease (assessed by the number of diseased vessels in the treated limb) correlated with a lower frequency of PTA procedure complications. There was no statistically significant difference in the complications, in the primary success or in the long-term results using either the femoral or popliteal route. However, the popliteal approach improved the early success of the originally antegrade access group by 6% and increased by about one-fifth the number of patients considered technically feasible for PTA in femoral artery occlusions. PTA can be used in femoral artery occlusions up to 10 cm long and it is especially suitable in femoral artery occlusions not exceeding 5 cm in length. PTA can be tried in femoral artery occlusions exceeding a length of 10 cm if operative treatment is not suitable.

Angioplasty, Balloon, Coronary↗
PubMed2003

Cytokine signatures in atherosclerotic claudicants.

BACKGROUND: Iron accumulation and inflammation may affect atherosclerosis. This study intended to define a cytokine signature in atherosclerotic claudicants and to determine whether reduction in serum ferritin by phlebotomy influenced this pattern. METHODS: Ninety-one subjects with peripheral vascular disease (PVD; mean age, 67 years) were recruited from the VA Cooperative Iron and Atherosclerosis Study (FeAST) testing the hypothesis that ferritin reduction to 25 ng/ml may ameliorate atherosclerosis. Cytokines TNF-a, IL-2, IL-6, and IL-10 were analyzed by enzyme amplified sensitivity assay (EASIA). Fasting iron and cholesterol panels, complete blood count, C-reactive protein (CRP), uric acid, fibrinogen, glucose, and hemoglobin A1c levels were also quantified. Values were compared with "healthy" controls (n = 21; mean age, 56 years). After randomization of PVD to phlebotomy (intervention group [IG], n = 44) or control (nonintervention group [NG], n = 47), analyses were compared at 6 and 12 months using t test, Wilcoxon rank sum test, chi-square, and robust MM regression. FINDINGS: Age, glucose, and hemoglobin A1c were higher in PVD compared with healthy controls (P < 0.01), whereas serum iron (P < 0.01) and percentage of transferrin saturation (P < 0.05) were lower. Tumor necrosis factor-alpha (TNF-alpha; P < 0.05), IL-6 (P < 0.01), and CRP (P < 0.05) levels were higher in the PVD group, whereas IL-10 was lower (P < 0.01). At 6 months post phlebotomy, ferritin levels were reduced (P < 0.01), although ferritin levels were reduced less in smokers. IL-6 and fibrinogen, CRP and ferritin levels correlated positively. At 6 and 12 months, subjects with TNF-alpha (n= 15) and IL-6 (n = 10) levels in the upper 25th percentile were reduced by phlebotomy. INTERPRETATION: An inflammatory cytokine signature exists in atherosclerosis. Elevated levels of TNF-alpha and IL-6, reportedly associated with recurrent and future myocardial infarction, were reduced by phlebotomy. The utility of the iron/inflammatory hypotheses will ultimately relate to clinical outcomes obtained prospectively by the FeAST trial.

Aged↗
PubMed2004

[Angioplasty with stenting for buttock claudication].

We report the case of a patient presenting severe buttock claudication with normal neurologic and osteoarticular exams. He underwent a guidewire recanalization of his occluded superior gluteal artery followed by a percutaneous angioplasty with stenting, resulting in total relief of symptoms. This observation represents the first publication describing the use of a stent with recanalization of the gluteal artery. The technique seems promising for buttock pathology.

Angioplasty, Balloon↗
PubMed1998

Claudication on mastication following bilateral external carotid artery ligation for posterior epistaxis.

This case highlights a potentially disabling complication of intermittent claudication in the region of the masseter muscles on mastication, following bilateral external carotid artery ligation for epistaxis. Although there have been few reports of this complication this may be a reflection of the fact that the operation is rarely performed, and not because the complication is rare. Its potentially disabling nature, and its possible common occurrence after this procedure make awareness of it by surgeons who may carry out this procedure important.

Carotid Artery, External↗