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PubMed2004

Unusual cause of intermittent claudication.

Spontaneous dissection of a peripheral artery is a rare event. We report a case of a spontaneous, non-atherosclerotic and non-aneurysmal dissection limited to the external iliac artery in a 60-year-old woman who was admitted with a left calf claudication. Non-invasive examination documented signs of leg ischemia due to a floating wall dissection of the external iliac artery. After medical treatment over eight weeks the dissection membrane had been adapted to the vessel wall. A similar case of a spontaneous dissection limited to the external iliac artery, followed by a spontaneous healing has not been reported in the literature.

Aortic Dissection↗
PubMedDate not supplied

The medical treatment of patients presenting with intermittent claudication secondary to atherosclerosis.

Peripheral vascular disease affects a large number of elderly people but is symptomatic in only a few cases. Most of these will not be considered for surgical or radiological revascularisation procedures unless their disease affects the suprainguinal vessels. The traditional advice to stop smoking and keep walking is important but, in addition, thought should be given to the secondary prevention of cardiovascular disease in these patients. Thorough assessment and modification of their risk factors, including their lipid status, should be performed and aspirin should be prescribed to all patients who can tolerate it.

Arteriosclerosis↗
PubMed2003

[Antiischemic efficacy of trimetazidine in patients with intermittent claudication and effort angina].

Male patients (n=42) with atherosclerosis obliterans and stage IIA-III ischemia of lower extremities combined with class II-III angina pectoris were divided into 2 groups. Patients of group 1 (n=21) were given simvastatin (10-20 mg/day), clopidogrel (75 mg/day) and trimetazidine (60 mg/day) for 6 months, those of group 2 - simvastatin and clopidogrel also for 6 months. Statistically significant decreases of frequency of attacks of angina, nitroglycerine consumption and increases of walking distance occurred only in group 1.

Aged↗
PubMed1992

Double-blind comparison of captopril with nifedipine in hypertension complicated by intermittent claudication.

In a double-blind, crossover trial 12 patients with hypertension and peripheral arterial disease were randomized to three months' treatment with captopril 25-50 mg twice daily or nifedipine SR 20-40 mg twice daily. While both treatments were equally effective at lowering blood pressure, postexercise calf blood flow availability was greater during treatment with captopril (P less than 0.04). This was not reflected in walking capacity assessed by treadmill exercise. The results suggest that both captopril and nifedipine are appropriate antihypertensive agents in patients with peripheral arterial disease.

Blood Pressure↗
PubMed1976

The value of Doppler blood velocity tracings in the detection of aortoiliac disease in patients with intermittent claudication.

Velocity tracings obtained with a Doppler ultrasound probe located over the common femoral artery have been evaluated as to their ability to predict the state of the proximal aortoiliac segment. Aortography was used as the assessor of the extent of aortoiliac disease. Five parameters of the tracings sensitive only to aortoiliac disease were submitted to miltivariate analysis. The probability of the aortoiliac segment having greater or less than 10% stenosis was calculated. In 86% of limbs, a high probability of diagnostic value and practical use resulted.

Aorta, Abdominal↗
PubMed1982

Observations on changes in intermittent claudication after the administration of creatine phosphate.

A study was carried out in 13 patients with stabilized occlusive arterial disease to assess the effect of treatment with creatine phosphate (800 mg/day for 12 days) on walking distance to onset of disabling pain and on haemodynamic parameters (Winsor Index and calf arterial blood flow after ischaemia). Before treatment, patients had daily exercise for 12 days on a treadmill to plateau walking distance increase due to exercise. The results showed a further significant increase in walking distance after treatment, and a significant increase in peak reactive hyperaemia in all but 2 patients. The possible mechanisms of the effects of creatine phosphate are discussed.

Adult↗
PubMed1977

[Success of physiotherapeutic interval training combined with standardized hemoderivative in intermittent claudication (author's transl)].

In a cross-over trial with 114 patients, intravenous Actovegin or an oral placebo were administered in addition to basic physiotherapy. In the evaluation 105 of the subjects were taken into consideration. It was shown that the test group (n = 53) achieved a 12% increase in walking distance (measured in the standardized walking distance test) compared with the placebo group (n = 52). The therapeutic success rate, i.e. the evaluation base for the efficacy of basic physiotherapy was comparatively good and statistically confirmed at 69.8% and 73.1% for the two groups. From this it may be concluded that basic physiotherapy can be effectively supported by Actovegin.

Actihaemyl↗
PubMed1993

[Vascular complications in drug addicts. Intermittent claudication in a HIV seropositive heroin addict].

The widespread use of heroin has revealed the growing life-threatening complications consequent on drug practice. The effects of heroin on the cardiovascular, pulmonary, renal and central nervous system have been well described in medical literature, but the vascular complication of chronic occlusive arterial disease of the lower limbs is rare. We report a case of a young female patient who was a chronic drug addict for over five years, with concomitant serum positiveness for HIV infection. The etiologic and pathogenetic mechanisms of such an uncommon vascular complication are discussed on the basis of the existing literature.

Adult↗
PubMed1978

[Active therapeutic exercises in combination with vasoactive drug in intermittent claudication (author's transl)].

Earlier investigations have shown that the success of physiotherapeutic exercises in peripheral arterial circulatory disturbances in stage II (Fontaine) can be increased by additional administration of "vasoactive" substances. In the present double-blind study, therefore, 102 outpatients were treated with magnesium nicotinate-magnesium dehydrocholate or a placebo in addition to basic physical therapy. The drug collective (n = 50) showed an increase in walking distance of 24.1% compared with the placebo group (n = 52). Also, in respect to the success rate, the drug collective did better, which, however, may have been due to the unequal distribution of the prognosis factors. Yet it may be concluded that the physiotherapeutic exercises can be effectively supported by the drug tested.

Aged↗
PubMed1989

[Principles of care of patients with intermittent claudication].

Care of patients with ischaemic disease of lower extremities (IDLE) in the claudication stage is aimed at the treatment of basal arterial disease and moderation of ischaemia. In apt patients it is necessary to indicate some of revascularization procedures (reconstruction surgery, angioplasty, fibrinolysis). All patients with arterial obliterating disease to observe recommended measures in regimen, consisting of continuous nicotine abstinence and elimination of risk factors for IDLE. These measures together with regular muscle training will in most patients in 2nd stage of IDLE slow down the progression of the disease. Regular check-ups by the attending doctor should early reveal threatening complications. Drug treatment in this stage of IDLE is aimed especially to thrombosis prevention and slowing down of arterial changes and improvement of microcirculation.

Humans↗
PubMed2002

Oxygen saturation measurement of calf muscle during exercise in intermittent claudication.

OBJECTIVES: to evaluate the oxygen saturation of the calf muscle measured by means of spatially resolved spectroscopy (SRS) in claudicants. METHODS: a total of 150 legs in 84 consecutive patients with calf claudication were studied by SRS. Oxygen saturation (SmO(2)) and the relative changes in oxygenated haemoglobin (HbO(2)) and deoxygenated haemoglobin (Hb) of the gastrocnemius muscle were measured during a treadmill walking test (2.4 km/h, 12%, 5 min). RESULTS: exercise was associated with a decrease in HbO(2) and an increase in Hb. There was no difference in SmO(2) at rest among all groups. The decrease oxygen saturation correlated well with the severity of symptoms of IC. CONCLUSION: muscle oxygen saturation measurement by SRS can be used clinically to provide objective information regarding the severity of IC.

Adult↗
PubMed2001

Treatment efficacy of intermittent claudication by surgical intervention, supervised physical exercise training compared to no treatment in unselected randomised patients I: one year results of functional and physiological improvements.

OBJECTIVES: to compare the effect of surgery, exercise and simple observation on maximum exercise power in claudicants. DESIGN: prospective, randomised study. METHODS: a total of 264 unselected claudicants were randomised to supervised exercise training, invasive treatment (open surgical or endovascular procedures) or observation. One year treatment outcomes were analysed on an intention to-treat basis. RESULTS: invasively treated patients showed a significant improvement in maximum walking power, stopping distance, post-ischaemic blood flow and big toe pressure at one year. Patients randomised to physical exercise training or to the control group did not improve in any outcome measure. CONCLUSION: invasive treatment increased walking capacity, leg blood pressure and flow. Supervised physical exercise training offered no therapeutic advantage compared to untreated controls.

Adult↗
PubMed1997

Effects of serial percutaneous application of carbon dioxide in intermittent claudication: results of a controlled trial.

In a prospective, controlled clinical trial, serial application of carbon-dioxide-enriched water was compared with fresh water. Twenty-four patients with peripheral arterial occlusive disease (stable claudication) were randomly allocated to one of two serial intervention groups, lower extremities immersed in either fresh water or in CO2-enriched water (1000 mg CO2/kg) water under standardized conditions (temperature, 33 degrees C; depth, 40 cm; immersion time, 30 min; five times a week over 4 weeks). The serial application of carbon-dioxide-enriched water increased arterial peak flow (reactive hyperemia), transcutaneous oxygen tension (basal value and half-recovery-time), and pain-free walking distance. The serial fresh water application did not change these values. The authors conclude that serial carbon dioxide application can be clinically effective in patients with arterial obstructions in the lower extremities.

Adult↗
PubMed1987

Placebo-controlled comparison of captopril, atenolol, labetalol, and pindolol in hypertension complicated by intermittent claudication.

In a six month placebo-controlled cross-over trial twenty patients with hypertension and peripheral arterial disease were randomised to captopril 25 mg twice daily, atenolol 100 mg once daily, labetalol 200 mg twice daily, or pindolol 10 mg twice daily for one month. Although all treatments were equally effective at lowering blood pressure, pain-free and maximum walking distances on a treadmill were decreased by atenolol, labetalol, and pindolol, but not by captopril. Post-exercise calf blood flow availability was impaired by atenolol, labetalol, and pindolol, but not by captopril. Despite ancillary characteristics of cardioselectivity, intrinsic sympathomimetic activity, or combination with alpha-blockade, beta-blockers seem to impair the lower limb circulation in such patients, whereas captopril seems to preserve it, possibly by maintaining the collateral blood supply.

Atenolol↗
PubMed1988

Efficacy of indobufen in the treatment of intermittent claudication.

The aim of this trial was to assess the activity of indobufen compared with placebo in peripheral occlusive arterial disease of the lower limbs of atherosclerotic or diabetic origin. Fifty-two outpatients were admitted to the randomized, double-blind study and were given either an indobufen 200-mg tablet (28 subjects) or placebo (24) for six months. Painfree walking distance on a treadmill at a constant speed (4 km/h) and slope (10 degrees) was assessed before and after three and six months' treatment. The painfree walking distance before treatment with indobufen or placebo averaged 153 +/- 23.02 (mean +/- SE) and 199 +/- 30.58 (mean +/- SE) meters respectively. After six months' treatment with active drug or placebo, this parameter reached 610 +/- 115.36 (p less than 0.01) and 243 +/- 32.49 (p greater than 0.05) meters respectively. The difference between the two treatments was statistically significant in favor of indobufen (p less than 0.01 Dunn's test).

Clinical Trials as Topic↗
PubMed2006

F wave studies of neurogenic intermittent claudication in lumbar spinal stenosis.

OBJECTIVE: Lumbar spinal stenosis (LSS) may result in neurogenic claudication (NC), which is thought to be a result of transient ischemia during exercise. In this study we evaluated the changes in F wave studies before and immediately after walking stress in patients with NC. DESIGN: Twenty-six patients with LSS who had signs and symptoms of NC and 20 healthy volunteers were included in this study. Routine motor and sensory nerve conduction studies and tibial F wave studies were performed in both groups. Immediately after walking stress test, tibial F wave studies were repeated. Exercise treadmill protocol was used for ambulation. Time to first symptoms and total ambulation time were recorded. RESULTS: After completion of the baseline electrophysiological examination, a walking stress test was performed using a treadmill, and 16 patients (61.5%) experienced neurogenic claudication during the trial. The mean time to first symptoms was 2.0 +/- 3.5 mins (minimum = 0, maximum = 14). In the control group 18 subjects (90%) completed the trial without any symptoms, and 2 (10%) subjects had to stop at an average of 10 mins because of generalized fatigue. Within 5 mins after the walking stress test, tibial F wave studies were repeated in both groups. There were significant increases in F latency values bilaterally in the patient group (P = 0.001 for both sides) but not in control subjects (P = 0.435 for right side and P = 0.122 for left side). CONCLUSION: Our data suggest that F wave studies after walking stress test provide more information for the diagnosis of NC.

Case-Control Studies↗
PubMed2006

High-intensity interval training for intermittent claudication in a vascular rehabilitation program.

This article reports an observational study investigating the safety and effectiveness of a high-intensity interval exercise program for patients with peripheral arterial disease. Patients were asked to walk on a treadmill to maximal claudication pain six times in each exercise session, with 3-minute rests in between. Once a patient could walk continuously for 6 minutes without reaching maximal pain, speed and/or grade was increased. To account for the changes in speed and grade, patients' walking ability was measured as a rehabilitation score, calculated as the product of the two. A total of 47 patients were included in the study. Results showed overall improvement in the rehabilitation score with participation in the program, and specifically showed that participation in more exercise sessions led to greater improvement. Moreover, no adverse events occurred in the study patients, suggesting patients with peripheral arterial disease can safely tolerate high-intensity exercise programs.

Activities of Daily Living↗
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↗