Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “CLAUDICATION”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 109 records · Page 6Linked to original sources
PubMed2001

Buflomedil for intermittent claudication.

BACKGROUND: Intermittent claudication is pain, caused by chronic occlusive arterial disease, that develops in a limb during exercise and is relieved with rest. Buflomedil is a vasoactive agent claimed to have beneficial effects on the microcirculation. It is used chiefly to treat peripheral vascular disease and to a lesser extent for cerebrovascular arterial disease. However, its clinical efficacy for intermittent claudication has not yet been critically examined. OBJECTIVES: To evaluate the available evidence on the efficacy of buflomedil for intermittent claudication. SEARCH STRATEGY: We searched Medline, International Pharmaceutical Abstracts (IPA) and the Cochrane Controlled Trials Register. Abbott Laboratories, the distributor of buflomedil, was asked to provide reports of controlled clinical trials. Reference lists of retrieved articles were checked, and enquiries sent to authors of known trials, to identify additional trials. Finally, we conducted a Science Citation Index search. SELECTION CRITERIA: Trial reports had to be double-blinded, randomized, and conformed to our PIO-criteria (Patients, Intervention, Outcome) to be considered for inclusion. Patients were required to have proven intermittent claudication (Fontaine stage II); the intervention was to be oral administration of buflomedil compared to placebo; and outcomes had to include pain-free walking distance (PFWD) and maximum walking distance (MWD) analysed by standardized exercise test. DATA COLLECTION AND ANALYSIS: Searches of bibliographic databases yielded three eligible randomized controlled trials (RCTs) and a meta-analysis referring to nine eligible trials. Two of these nine trials had already been identified; two had been published in journals not referenced in traditional bibliographic indexes; and five were unpublished. Despite multiple requests, only one of the five unpublished trials was provided by the author of the meta-analysis, the other four could not be retrieved. Four of the six eligible trials retrieved were subsequently excluded after quality evaluation. Data on walking distances were extracted from the two remaining trials. Differences in incremental gain between active and placebo groups for PFWD and MWD with their confidence intervals were calculated. MAIN RESULTS: Both RCTs showed moderate improvements in PFWD for patients on buflomedil. In one trial this improvement (75 m, 95% CI 37-114) was statistically significant, but in the other, with a wholly diabetic population, it was non-significant (81m, 95% CI -9-170) compared to placebo. For both RCTs the gains in MWD were statistically significant, but with wide confidence intervals (81 m, 95% CI 30-131; and 171 m, 95% CI 27-316 respectively). Pooling of the data was not attempted. REVIEWER'S CONCLUSIONS: There is little evidence available to evaluate the efficacy of buflomedil for intermittent claudication. Most available trials are of poor quality and were excluded. The two trials included showed moderately positive results but these are undermined by publication bias since we know of another four unpublished, irretrievable, and inconclusive studies. There is a lack evidence for the efficacy of buflomedil in intermittent claudication.

Administration, Oral↗
PubMed2001

Anticoagulants (heparin, low molecular weight heparin and oral anticoagulants) for intermittent claudication.

BACKGROUND: Anticoagulant treatment for intermittent claudication might improve functional capacity, and prevent acute cardiovascular complications caused by peripheral obstructive arterial disease. OBJECTIVES: To assess the effects of anticoagulant drugs (heparin, low molecular weight heparin (LMWH) and oral anticoagulants) in patients with intermittent claudication (Fontaine stage II) in terms of improving walking capacity (pain-free walking distance or absolute walking distance), mortality, cardiovascular events, ankle/brachial pressure index, progression to surgery, amputation-free survival and side effects of these drugs. SEARCH STRATEGY: Randomised trials of anticoagulants for intermittent claudication were sought using the search strategy described by the Cochrane Peripheral Vascular Diseases Review Group. Additional trials were sought through: reference lists resulting from this search; recent conference proceedings; contact with authors of published trials and pharmaceutical companies producing anticoagulants. SELECTION CRITERIA: All randomised trials of anticoagulants used to treat patients with intermittent claudication. DATA COLLECTION AND ANALYSIS: Thirteen trials were initially considered eligible for inclusion in the review. Two studies evaluated oral anticoagulants, five evaluated standard heparin, and six evaluated LMWHs. Only three studies (two evaluating oral anticoagulants, one evaluating heparin) met the high quality methodological inclusion criteria and were included in the primary analysis. Four other studies were included in the sensitivity analysis. The reviewers extracted the data independently. MAIN RESULTS: No significant difference was observed between heparin treatment and control groups for pain-free walking distance or maximum walking distance at the end of treatment. There were no data to indicate that LMWHs benefit walking distance. Revascularisation or amputation-free survival rates were reported in one study only with a five year follow-up. No study reported a significant effect on overall mortality or cardiovascular events and the pooled odds ratios were not significant for these outcomes either. Major and minor bleeding events were significantly more frequent in the group treated with oral anticoagulants compared to control, with a non-significant increase in fatal bleeding events. No major bleeding events were reported in the study evaluating heparin, while a non-significant increase in minor bleeding events was reported. REVIEWER'S CONCLUSIONS: No benefit of heparin, LMWHs or oral anticoagulants has been established for intermittent claudication. An increased risk of major bleeding events has been observed especially with oral anticoagulants. The use of anticoagulants for intermittent claudication cannot be recommended at this stage.

Administration, Oral↗
PubMedDate not supplied

Improvement in claudication after angioplasty of distal ostial collateral stenosis in patients with long-segment occlusion of the femoral artery.

PURPOSE: To evaluate the angiographic and clinical effects of percutaneous transluminal angioplasty (PTA) of distal ostial collateral stenoses in patients with claudication and long-segment occlusion of the superficial femoral artery (SFA). METHODS: In ten patients (9 men, 1 woman) with stable intermittent claudication due to chronic long-segment occlusion of the SFA a high-grade stenosis of the distal collateral ostium of the deep femoral artery to the popliteal artery were dilated. PTA was performed using popliteal artery access. Claudication distances on the treadmill and ankle-brachial pressure indices (ABI) at rest were analyzed before, 1 week, and 14 weeks after PTA. RESULTS: Initial technical success was obtained in all patients. There were no significant periprocedural local complications. The initial mean claudication distance on the treadmill increased significantly from 107 +/- 65 m to 306 +/- 209 m (p < 0.01), the maximal claudication distance from 203 +/- 128 m to 392 +/- 167 m (p < 0.01). The mean ABI changed slightly but significantly (0.61 +/- 0.08 vs. 0.64 +/- 0.07; p < 0.05). Early follow-up after 14 weeks revealed no clinical deterioration. CONCLUSION: This new technique is considered helpful in patients with well-defined claudication and long-segment occlusion of the SFA.

Aged↗
PubMed2005

Rapid foot and calf compression increases walking distance in patients with intermittent claudication: results of a randomized study.

OBJECTIVE: The aim of our pilot study was to determine the usefulness of rapid, high-pressure, intermittent pneumatic calf and foot compression (IPCFC) in patients with stable intermittent claudication, with reference to the end points of improvement in initial claudication distance (ICD) (distance at which patient feels pain or discomfort in the legs), and improvement in absolute claudication distance (ACD) (distance at which patient stops walking because the pain or discomfort becomes severe). METHODS: Thirty male patients presenting with stable, intermittent claudication (ACD between 50 and 150 meters on treadmill testing at 3.8 km/h, 10 degrees gradient) were recruited into this pilot study from a single center. Fifteen patients were randomized to treatment with IPCFC (applied for 1 hour twice daily in the sitting position) and were also advised to have daily exercise, and 15 patients served as controls, who were advised exercise alone. All patients received aspirin and had resting and postexercise ankle/brachial index (ABI) measured at enrollment along with ICD and ACD on treadmill testing (3.8 km/h, 10 degrees gradient). The mean age, baseline ICD, and ACD of the treatment and control groups were 70.4 +/- 7 years and 70.7 +/- 9 years, 55.8 +/- 15 meters and 68.4 +/- 17 meters, and 86.7 +/- 19 meters and 103.9 +/- 27 meters, respectively. Both groups were equally matched for risk factors, including smoking, type II diabetes mellitus, and hypercholesterolemia. IPCFC was applied. The study protocol included follow-up visits at 1, 2, 3, 4, 6, and 12 months with the ABI, ICD and ACD being measured at every visit. RESULTS: The percent change from baseline for ICD and ACD for each patient visit and the mean +/- standard deviation (SD), standard error (SE), and median were calculated for the control and treatment groups. The percent change from baseline measurements (mean +/- SD) for ICD and ACD in the control group at 4, 6, and 12 months were 2.2 +/- 18 and 2.3 +/- 18, 2.9 +/- 17 and 5.2 +/- 20, and 3.6 +/- 18 and 5.8 +/- 20, respectively. In contrast, the changes in ICD and ACD at 4, 6, and 12 months in the treatment group were 137.1 +/- 128 (P < .01) and 84.3 +/- 82 (P < .01), 140.6 +/- 127 (P < .01) and 96.4 +/- 106 (P = .01), and 150.8 +/- 124 (P <0.01) and 101.2 +/- 104 (P <0.01), respectively. Although the ABI showed a slight increase in the treatment group, these differences were not statistically significant. CONCLUSIONS: The results of this pilot study show that IPCFC improves walking distance in patients with stable intermittent claudication. A significant increase in ICD and ACD was seen at 4 and 6 months of treatment, respectively, and the improvement was sustained at 1 year. The combination of IPCFC with other treatment such as risk-factor modification and daily exercise may prove useful in patients with peripheral arterial occlusive disease. It may be a useful first line of therapy in patients with disabling claudication who are unfit for major reconstructive surgery. Improved walking on long-term follow-up and experience from different centers may establish a role for this treatment modality in the future.

Administration, Oral↗
PubMed2006

Association of obesity and metabolic syndrome with the severity and outcome of intermittent claudication.

BACKGROUND: Obesity is recognized as an independent predictor of coronary artery disease; however, its importance in peripheral arterial disease is less clear. The aim of this study was to assess the association between obesity and the severity and outcome of intermittent claudication. METHODS: This study was a prospective cohort study based at a tertiary referral center. Sixty patients with intermittent claudication selected for conservative treatment were assessed for obesity and metabolic syndrome by using the International Diabetes Federation definition. Other risk factors, including diabetes, hypertension, smoking history, serum lipids, adipocytokines, and C-reactive protein, were measured by clinical and blood assessment. Obesity and metabolic syndrome were related to the severity of peripheral arterial disease, defined by ankle-brachial pressure index and graded treadmill measured maximum walking distance (MWD) and initial claudication distance, by using multiple linear regression analysis allowing for traditional atherosclerotic risk factors. Patients were followed up for 24 months, and combined outcome was reported in terms of death, cardiovascular events, or requirement for revascularization. The effect of obesity and metabolic syndrome on outcome was investigated by using Kaplan-Meier and Cox proportional hazard analysis. RESULTS: Obesity and serum adiponectin were independently associated with the severity of peripheral arterial disease measured by ankle-brachial pressure index (P = .03 and .001), initial claudication distance (P = .009 and .03), and MWD (P = .001 and .04). Metabolic syndrome was independently associated only with MWD (P = .02). By 24 months, outcome events occurred in 37% +/- 7% and 43% +/- 9% of patients with metabolic syndrome or obesity, respectively, compared with 0% and 11% +/- 6% of those without these diagnoses. Waist circumference independently predicted the likelihood of outcome events (relative risk, 1.16; 95% confidence interval, 1.08-1.26; P < .001). CONCLUSIONS: These findings, if confirmed in other cohorts, suggest the importance of treating obesity in patients with intermittent claudication. Serum adiponectin concentrations may be an important guide to the efficacy of treatment in patients with intermittent claudication and obesity.

Aged↗
PubMed2001

Propionyl-L-carnitine improves exercise performance and functional status in patients with claudication.

PURPOSE: We tested the hypothesis that propionyl-L-carnitine would improve peak walking time in patients with claudication. Secondary aims of the study were to evaluate the effects of propionyl-L-carnitine on claudication onset time, functional status, and safety. SUBJECTS AND METHODS: In this double-blind, randomized, placebo-controlled trial, 155 patients with disabling claudication from the United States (n = 72) or Russia (n = 83) received either placebo or propionyl-L-carnitine (2g/day orally) for 6 months. Subjects were evaluated at baseline and 3 and 6 months after randomization with a graded treadmill protocol at a constant speed of 2 miles per hour, beginning at 0% grade, with increments in the grade of 2% every 2 minutes until maximal symptoms of claudication forced cessation of exercise. Questionnaires were used to determine changes in functional status. RESULTS: At baseline, peak walking time was 331 +/- 171 seconds in the placebo group and 331 +/- 187 seconds in the propionyl-L-carnitine group. After 6 months of treatment, subjects randomly assigned to propionyl-L-carnitine increased their peak walking time by 162 +/- 222 seconds (a 54% increase) as compared with an improvement of 75 +/- 191 seconds (a 25% increase) for those on placebo (P <0.001). Similar improvements were observed for claudication onset time. Propionyl-L-carnitine treatment significantly improved walking distance and walking speed (by the Walking Impairment Questionnaire), and enhanced physical role functioning, reduced bodily pain, and resulted in a better health transition score (by the Medical Outcome Study SF-36 Questionnaire). The incidence of adverse events and study discontinuations were similar in the two treatment groups. CONCLUSIONS: Propionyl-L-carnitine safely improved treadmill exercise performance and enhanced functional status in patients with claudication.

Adult↗
PubMed2002

Vitamin C prevents endothelial dysfunction induced by acute exercise in patients with intermittent claudication.

In patients with intermittent claudication, exercise is associated with a marked increase in oxidative stress, likely responsible for systemic endothelial perturbation. In 31 claudicant patients, we assessed the effect of vitamin C administration on the acute changes induced by maximal and submaximal exercise in endothelium-dependent, flow-mediated dilation (FMD), and in plasma levels of thiobarbituric acid-reactive substances (TBARS) and soluble intercellular adhesion molecule-1 (sICAM-1). In 16 claudicants, maximal exercise reduced FMD (from 8.5+/-0.9 to 3.7+/-0.8%, P<0.01), and increased plasma levels of TBARS (from 1.93+/-0.06 to 2.22+/-0.1 nmol/ml, P<0.02) and of sICAM-1 (from 282+/-17 to 323+/-19 ng/ml, P<0.01). In eight of these patients, randomized to vitamin C, exercise-induced changes in FMD and biochemistry were abolished. This beneficial effect was not observed in the eight patients randomized to saline. In 15 patients, who walked until the onset of claudication pain (submaximal exercise), and in ten control subjects, who performed maximal exercise, no changes were observed with exercise. Thus, in claudicants, vitamin C prevents the acute, systemic impairment in endothelial function induced by maximal exercise. This finding provides a rationale for trials investigating antioxidant therapy and cardiovascular risk in patients with intermittent claudication.

Antioxidants↗
PubMed1999

The effect of alpha-tocopherol and beta-carotene supplementation on symptoms and progression of intermittent claudication in a controlled trial.

We evaluated the effect of long-term supplementation with vitamin E (alpha-tocopherol) and beta-carotene on occurrence of claudication symptoms and risk for peripheral vascular surgery among men with intermittent claudication. Subjects, 50-69-year old male smokers, were participants in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, who reported intermittent claudication through a structured questionnaire (Rose) at study entry (n=1484). They were randomly assigned to receive either 50 mg/day of alpha-tocopherol, or 20 mg/day of beta-carotene, or both, or placebo, in a 2 x 2 design. During follow-up, claudication was evaluated by repeating use of the questionnaire once a year. Information on peripheral vascular surgery came from the National Hospital Discharge Register. We observed no effect of alpha-tocopherol and beta-carotene supplementation on claudication during a mean follow-up of 3.7 years. A slightly increased risk (odds ratio (OR) 1.60, 95% confidence interval (CI) 1.05-2.44) for vascular surgery was observed among beta-carotene supplemented men compared to those who did not receive beta-carotene. Alpha-tocopherol supplementation had no effect. In conclusion, long-term supplementation with alpha-tocopherol and beta-carotene showed no beneficial effect on symptoms and progression of intermittent claudication.

Aged↗
PubMed1996

Utility of routine carotid duplex screening in patients who have claudication.

PURPOSE: The recently published Asymptomatic Carotid Atherosclerosis Study (ACAS) demonstrated the benefit of performing carotid endarterectomy in selected asymptomatic patients who have > 60% carotid stenoses. It therefore becomes clinically important to identify the subgroups of patients who have a sufficiently high incidence of high-grade carotid stenosis to warrant routine carotid duplex screening. METHODS: To determine the incidence of asymptomatic carotid disease in patients who had a chief complaint of claudication, we evaluated 188 patients who had claudication and no history of cerebrovascular symptoms. After a complete history was taken and a physical examination performed, patients underwent standard lower-extremity noninvasive vascular laboratory studies and carotid duplex scanning. Carotid duplex findings were interpreted by the Strandness criteria. Associated atherosclerotic risk factors were assessed (patient age, male sex, diabetes, hypertension, smoking history, lipid levels, history of coronary artery disease, coronary or vascular surgery, and family history of cerebrovascular disease). Presence of a carotid bruit was also noted. Univariate analysis, logistic regression, and odds ratios were performed to identify subgroups of patients that had an increased incidence of significant carotid disease. RESULTS: Of the 188 patients with claudication who were screened, 8% had an internal carotid artery stenosis of 16% to 49%, 21.8% had a stenosis that exceeded 50%, and 2.7% had an occluded internal carotid artery. The presence of a carotid bruit on physical examination was predictive of a > or = 50% internal carotid artery stenosis (p = 0.027). The ankle-brachial index was highly predictive of the presence of carotid stenoses in an inverse relationship (p = 0.001). Patient age approached significance (p = 0.143). Patients older than 65 years of age who had claudication, an ankle-brachial index less than 0.7, and a carotid bruit had a 45% incidence of significant carotid disease. The atherosclerotic risk factors of male sex, diabetes, hypertension, hyperlipidemia, smoking history, coronary history, previous coronary or vascular surgical history, and family history were not predictive of the presence of a > 50% carotid stenosis. CONCLUSIONS: In patients who seek medical attention with the chief complaint of claudication and who have no cerebrovascular symptoms, there is a 24.5% incidence of a > 50% internal carotid artery stenosis or occlusion on duplex examination. Select subsets of these patients have upwards of a 45% incidence of significant asymptomatic carotid disease. All patients who seek medical attention with claudication should therefore undergo routine carotid duplex screening to detect asymptomatic high-grade stenosis.

Aged↗
PubMed1999

Peripheral blood flow rates and microvascular responses to orthostatic pressure changes in claudicants before and after revascularisation.

OBJECTIVES: To study the effect of arterial reconstruction for occlusive atherosclerotic disease with intermittent claudication on blood flow rate during rest and on microvascular responses to orthostatic pressure changes in the pulp skin of the first toe where arteriovenous anastomoses are numerous. MATERIAL: Eleven patients with Fontaine IIa claudication (ankle blood pressure index > 0.30) before and 7 (range: 2-11) months after intervention. METHODS: Blood flow rate was measured by the heat washout method with the toe at heart level and after passive lowering to 50 cm below this level using a Clark type electrode with thermostatically controlled cap that was fixed to the pulp of the first toe by adhesive tape. RESULTS: At heart level, blood flow rate was lower in claudicants before reconstruction as compared to a group of previously published control subjects (p = 0.0076, Wilcoxon), blood flow rate increased in claudicants from before to after intervention (p = 0.0128), and postoperative blood flow rate was like that of normals (N.S.). Before surgery, blood flow rate in claudicants increased in median with a factor of 1.79 during lowering (p < 0.0051). CONCLUSIONS: The disturbance of the microcirculatory responses to orthostatically induced pressure changes in claudicants reverted towards normal after arterial reconstruction.

Aged↗
PubMed2000

Ground reaction force pattern in limbs with intermittent claudication.

OBJECTIVES: to investigate the presence of a ground reaction force pattern specific to the patient with unilateral intermittent claudication (IC), and the relationship of this pattern with onset of claudication. DESIGN: identification of impulse pattern during gait of lower limbs with and without ischaemia, in patients with unilateral IC and controls. METHODS: thirty patients with unilateral IC and six peripheral arterial disease non-claudicant patients had their gait recorded using the F-Scan system during a treadmill test. Their plantar impulse pattern was calcuated. Examined lower limbs were subdivided into groups: ischaemic limbs (30), contralateral limbs (30) and lower limbs of patients without IC (12). Two impulse patterns were found: the descending one, where impulse values decrease during gait, and the non-descending one, where these values do not decrease during gait. The numerical distribution of patterns among limb groups was determined and their ratios compared. Correlation between claudication onset and impulse pattern was also investigated. RESULTS: most ischaemic limbs exhibited a descending pattern, in contrast with control and contralateral non-ischaemic limbs (p<0.02). There was no relationship between impulse pattern and claudication onset. CONCLUSIONS: ischaemic lower limbs present the descending pattern of plantar impulse. No relationship exists between this pattern and claudication pain.

Adult↗
PubMed2000

Assessment of generic health-related quality of life in patients with intermittent claudication.

OBJECTIVES: to measure quality of life in patients with intermittent claudication and evaluate the ability of patients and vascular surgeons to make a similar assessment. DESIGN, MATERIALS AND METHODS: in this prospective study patients with intermittent claudication attending two vascular clinics were asked to complete a generic health-related quality of life instrument (MOS SF-36). Patient quality of life and vascular surgeons' assessment of patient quality of life were further evaluated using a single question/adjectival scale response combination. RESULTS: patients' self-assessment of their quality of life correlated better with the SF-36 score than did the surgeons' assessment. There was little correlation between the surgeons' and patients' own assessment of quality of life. The surgeons differed significantly from each other in their assessments. Claudicants had lower SF-36 scores than population norms in pain and physical aspects of quality of life. CONCLUSIONS: claudicants have worse quality of life than the general population, with pain and physical limitations being the most important domains. Surgeons predict the quality of life of claudicating patients less accurately than patients do themselves, and may differ from their colleagues in such assessments. Objective quality of life assessment in claudicants should be undertaken before treatment is decided.

Adult↗
PubMed2003

The effect of peripheral percutaneous transluminal angioplasty on quality of life in patients with intermittent claudication.

BACKGROUND AND OBJECTIVE: intermittent claudication is associated with a significant reduction in quality of life. Treatment of claudicants aims to reduce mortality from cardio- and cerebro-vascular events and to improve quality of life. Quality of life assessment should be used to guide and evaluate treatment in this group of patients. Peripheral percutaneous transluminal angioplasty (PTA) is now widely used in the treatment of intermittent claudication. The aim of this review is to examine the effect of PTA on quality of life (QOL) in patients with intermittent claudication. METHODS: a review was conducted of prospective clinical trials assessing the effect of peripheral PTA on QOL. Publications were retrieved by searching Medline and PreMedline, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of systematic reviews, AMED and CINAHL. The reference lists of the relevant publications were also searched. RESULTS: seven prospective studies (10 publications) on the effect of PTA on QOL in claudicants were identified. Several different questionnaires were used to measure quality of life (Nottingham Health Profiile, SF-36, EuroQol) none of which were disease specific. All the studies showed some improvement in QOL after PTA at follow-up periods of between 6 weeks and 24 months, except for one which showed some improvement at 6 months but not at 24 months. CONCLUSIONS: despite the fact that studies on the effect of PTA on QOL in claudicants have used generic QOL questionnaires which are relatively insensitive, the findings suggest that PTA may result in some improvement in QOL in these patients, although level I evidence to support this is lacking. The availability of disease-specific questionnaires should enable a more accurate assessment of PTA on QOL in these patients.

Angioplasty, Balloon↗
PubMed2001

Effects of intermittent pneumatic compression of the calf and thigh on arterial calf inflow: a study of normals, claudicants, and grafted arteriopaths.

BACKGROUND: Recent data indicate that intermittent pneumatic compression (IPC) of the foot may offer benefits in patients with intermittent claudication exceeding those of standard medications approved by the Food and Drug Administration. IPC of the foot (IPC(foot)) and calf (IPC(calf)) increases flow velocity in infrainguinal arterial bypass grafts and thus may prevent arterial thrombosis. Our aim was to evaluate the acute effects of IPC of the thigh (IPC(thigh)), IPC(calf), and IPC of the thigh and calf (IPC(calf + thigh)) in healthy controls, claudicants, and arteriopaths who have undergone infrainguinal bypass grafting for critical or subcritical limb ischemia. METHODS: Sixteen limbs of normals (group A), 17 limbs of claudicants (group B), and 16 limbs of arteriopaths (group C) who had undergone infrainguinal autologous revascularization were studied. Blood flow was measured in the limbs of normals and claudicants in the popliteal artery and in the grafts of revascularized limbs by using duplex ultrasonography. Mean velocity (mV), peak systolic velocity, end diastolic velocity (EDV), pulsatility index (PI), and volume flow (Q) were measured in the sitting position at rest and within 10 seconds from the delivery of IPC(thigh), IPC(calf), and IPC(calf + thigh), IPC was delivered at maximum inflation and deflation pressures of 120 mm Hg and 0 mm Hg, respectively; inflation and deflation times of 4 and 16 seconds, respectively; and a proximal inflate delay of 1 second (calf compression preceding that of thigh). RESULTS: In all 3 groups with all IPC modes, the Q, mV, and EDV increased while PI decreased (P <.05). IPC(thigh) was less effective than IPC(calf), but still increased Q (by 114%, 57%, and 59.8% in groups A, B, and C, respectively) and EDV, while decreasing PI in all 3 groups (P <.05). IPC(calf + thigh) was the most efficient mode, generating an increase in the median Q of 424% in controls, 229% in claudicants, and 317% in grafted arteriopaths. The addition of IPC(thigh) to IPC(calf) increased the mV and Q in group A (P < or = .044); the mV, Q, and EDV in group B (P < or = .03), and mV and PI by 24% and -27% in group C, respectively. CONCLUSIONS: IPC applied to the thigh, either alone or in combination with IPC(calf), generates native arterial and infrainguinal autologous graft flow enhancement. The paucity of conservative methods available for lower limb blood flow augmentation may allow IPC of the lower limb to emerge as a reliable, noninvasive therapeutic option, ameliorating claudication and assisting infrainguinal bypass graft flow. IPC(thigh) adds to the armamentarium of currently known IPC options (foot or calf) promoting its applicability and efficacy.

Adult↗
PubMed1991

Intermittent claudication as a manifestation of silent myocardial ischemia: a pilot study.

One hundred consecutive patients with intermittent claudication were screened noninvasively with electrocardiography chest wall mapping stress test and transcutaneous aortovelography during bicycle ergometry. Electrocardiographic chest wall stress testing indicated three-vessel coronary disease in 25 patients and left anterior descending plus circumflex (left main stem equivalent) disease in seven. In these 32 patients transcutaneous aortovelography demonstrated a decrease in stroke distance (an index of cardiac stroke volume) (median, -28%; 90% range, +5% to -48%), and coronary angiography confirmed the presence and severity of the disease. The claudication distance ranged between 50 and 250 meters. After myocardial revascularization or medical therapy a significant increase occurred in the stroke distance after exercise (median, +20; 90% range, +40% to -25%); also a significant increase in the postexercise pressure index and a reduction in the recovery time (p less than 0.01). No change occurred in the ankle/pressure index at rest. Twelve patients were able to walk without being limited by claudication; 15 reported improvement with a two to tenfold increase in claudication distance. No change occurred in three. The results indicate that silent myocardial ischemia is a common finding in patients with intermittent claudication. It produces left ventricular dysfunction and a decrease in stroke volume leading to a large fall in ankle pressure and early onset of claudication during exercise. Niltrates and myocardial revascularization tend to reverse this.

Aged↗
PubMed1993

Claudication pain and hemodynamic responses to exercise in younger and older peripheral arterial disease patients.

BACKGROUND: Claudication patients who are candidates for exercise can frequently walk to maximal pain without experiencing exaggerated blood pressure and heart rate, as well as other clinical symptoms. However, these concomitant problems are more likely to become apparent as patients age. Consequently, this study compared the claudication and hemodynamic responses to exercise in younger and older peripheral arterial disease patients. METHODS: Forty younger (mean age 60.4 yr, range 55-62) and 51 older (mean age 75.5 yr, range 73-81) patients with stable claudication symptoms performed a progressive treadmill walking test to maximal leg pain. The times to onset and to maximal claudication pain, peripheral hemodynamic measurements (oximetry, ankle systolic pressure, and ankle-to-brachial systolic pressure index), and central hemodynamic measurements (heart rate and brachial blood pressures) were obtained. RESULTS: Onset and maximal claudication pain occurred 71 sec and 126 sec sooner (p < .05) in the older group, respectively. Greater reductions (p < .05) in foot transcutaneous oxygen tension, ankle systolic pressure, and ankle-to-brachial systolic pressure index were obtained during and following exercise in the older group. Furthermore, smaller increases (p < .05) in heart rate, brachial blood pressures, mean arterial pressure, and rate-pressure product were noted during exercise in the older group. CONCLUSIONS: Greater impairment in the peripheral hemodynamic measurements occurs without exaggerated heart rate and blood pressure responses in older claudication patients who walk to maximal leg pain compared with younger patients.

Age Factors↗
PubMed1989

Intermittent claudication--surgical reconstruction or physical training? A prospective randomized trial of treatment efficiency.

This study reports the initial evaluation of treatment efficiency in 75 patients with intermittent claudication who were randomized to three treatment groups: 1) reconstructive surgery, 2) reconstructive surgery with subsequent physical training, and 3) physical training alone. Before treatment, there were no statistically significant differences between the groups in age, sex, smoking habits, symptom duration of claudication, ankle-arm blood pressure quotient (ankle-index), maximal plethysmographic calf blood flow, symptom-free and maximal walking distance, the history of other atherosclerotic manifestations or in the medical treatment. The walking performance was improved in all three groups at follow-up 13 +/- 0.5 months after randomization. Surgery was most effective, but the addition of training to surgery improved the symptom-free walking distance even further. In pooled observations of the three groups, age, symptom duration, and a history of myocardial ischemic disease correlated negatively with walking performance after treatment. In the operated group, the duration of claudication and a history of myocardial ischemic disease correlated negatively with the walking performance. This was not the case when patients were censored if limited by other symptoms than intermittent claudication after treatment. In the trained group, the duration of claudication correlated negatively to symptom-free and maximal walking distance. Ankle-index and maximal plethysmographic calf blood flow after treatment and the change of these variables with treatment correlated positively with both symptom-free and maximal walking distance when results were pooled for all patients. Although this mainly was a consequence of the improved blood flow after surgery, the change of maximal plethysmographic calf blood flow also correlated with symptom-free but not with maximal walking distance in the trained group. The results demonstrate that, compared with physical training alone, operation alone or in combination with subsequent training are superior treatment modalities in patients with intermittent claudication.

Blood Vessel Prosthesis↗
PubMedDate not supplied

Stair climbing elicits a lower cardiovascular demand than walking in claudication patients.

PURPOSE: Peripheral arterial disease patients limited by claudication pain frequently have concomitant-cardiovascular problems during exercise, such as hypertension and myocardial ischemia. Thus, for testing and rehabilitation purposes, exercise which elicits lower heart rate and blood pressure at a given metabolic intensity would be preferred over a more demanding task. The purpose of this study was to compare the cardiovascular responses of claudication patients during walking and stair climbing at a similar level of oxygen uptake. METHODS: Ten patients limited by claudication pain performed treadmill walking and stair climbing tests. RESULTS: Oxygen uptake was similar (P > .05) during walking and stair climbing (13.7 vs. 13.5 mL/kg/min, respectively). The times to onset and to maximal claudication pain, as well as the peripheral hemodynamic measurements of ankle systolic pressure, ankle-to-brachial systolic pressure index, and foot transcutaneous oxygen tension were also similar between the two tests (P > .05). However, heart rate, systolic pressure, diastolic pressure, mean arterial pressure, and rate-pressure product values were lower during and following stair climbing than compared to walking (P < .05). CONCLUSION: Stair climbing may offer an advantage over treadmill walking for claudication patients because similar metabolic, claudication, and peripheral hemodynamic measurements are obtained with concomitantly less demand placed on the cardiovascular system. The stair climbing test was well tolerated and safely performed by each patient.

Aged↗