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PubMedDate not supplied

Pharmacological treatment of intermittent claudication: double blind controlled study of Sulodexide vs placebo.

A double blind placebo controlled randomized study was used to assess the clinical variations caused by Sulodexide treatment (100 mg/die) vs placebo in 30 patients with a mean age of 50.3 years suffering from peripheral arterial obstructive disease of the lower limbs (II stage). The general tolerance of the therapy was monitored over the medium-term. There were marked changes in the clinical signs and symptoms in the Sulodexide group, which showed a gradual constant improvement, while they were stationary in the placebo group. Confirmation of the marked improvement in the Sulodexide group was provided by the Winsor index which showed a significant increase in these patients while only a minimum variation was observed in the placebo group. The positive antithrombotic action of the active treatment led to an increase in the blood supply in previously ischemic regions, without creating haemorrhagic risks or disturbing the haemostatic balance. The absence of adverse reactions and good systemic tolerance is also noteworthy.

Adult↗
PubMed1983

[Stenoses and occlusions of the extracranial arteries. A field study of unselected subjects and patients with intermittent claudication].

Doppler sonography of the extracranial arteries was done in 556 unselected patients (greater than 40 years) in a prophylactic study. 226 high risk patients with arterial occlusive leg disease (AOD) served as control group. Doppler sonography revealed stenoses or occlusions of the carotid, vertebral and (or) subclavian arteries in 9.17% of normal persons and in 38.05% of AOD patients. Medical treatment is available only for stenoses (not occlusions) of the carotid arteries. Thus the frequency of asymptomatic internal carotid stenoses--only stenoses of more than 50% lumen diminution can be detected--of 2.33% in the group of normal probands and of 17.2% in the patient group is the reference value and justification for use of Doppler sonography for prophylactic assessment. The atraumatic and safe method with a success rate of 2.33% is suitable particularly in increased risk factors (age, males, smoking, hypertension, diabetes). As a prophylactic investigation in patients with arterial occlusive disease Doppler sonography is mandatory before prospective operations.

Adult↗
PubMed1982

Intermittent claudication in an athlete--popliteal artery entrapment: a case report.

This case study reports a 26 year old female athlete who presented with a history of cramp-like right calf pain. She was limited to a walking distance of only three blocks. She had been referred to the Sports Medicine Clinic with a diagnosis of "shin splints". On examination of the pedal pulses it was found that the right posterior tibial pulse was absent. A diagnosis of popliteal artery entrapment was made which was confirmed by Doppler studies following treadmill walking and femoral arteriograms. Surgery was performed which included resection of the entrapped artery by the plantaris tendon and endarterectomy, plus patch graft angioplasty. The artery had been completely occluded. The patient resumed full activity pain free. This case report emphasizes that all leg pains in athletes are not variants of "shin splints". Popliteal artery entrapment is an uncommon condition that requires early detection. A detailed history and thorough examination of the peripheral pulses is essential to prevent long term sequelae of arterial deficiency.

Adult↗
PubMedDate not supplied

Functional improvements following StairMaster vs. treadmill exercise training for patients with intermittent claudication.

BACKGROUND: Although there have been many studies showing that exercise training is beneficial for patients with peripheral vascular occlusive disease (PVOD), there is little research comparing various modes of training. Previous studies showed that exercise tests performed on a StairMaster (StairMaster Sports/Medical Products, Kirkland, WA) produce responses similar to those elicited by treadmill tests. The purpose of this study was to compare these modes of exercise in a training program for patients with PVOD. METHODS: Of the 23 eligible individuals who began the exercise program, 11 did not complete the regimen due to various complications. Thus, 12 patients were randomly assigned to train for 12 weeks on either a StairMaster (n = 6) or a treadmill (n = 6). Patients underwent progressive and single-stage exercise tests on both exercise modalities before and after training. RESULTS: Mean exercise time before the onset of claudication pain for all tests rose significantly after training (P <.01), but greater improvements were seen on the specific training apparatus (i.e., treadmill training resulted in improvement in treadmill exercise performance with less improvement noted when tested on the StairMaster, and vice versa). Exercise time to maximal pain increased for the training apparatus only (P <.01). There were no changes in foot transcutaneous oxygen tension or the ankle-brachial blood pressure index. CONCLUSIONS: Both StairMaster and treadmill training improve the exercise capacity of PVOD patients. The training effect is most apparent for the specific training apparatus, but there is some cross-over improvement to the other exercise modality. Thus, StairMaster training is appropriate and can be part of the exercise prescription for treatment of these patients.

Aged↗
PubMedDate not supplied

[Reconstructive surgery in arterial disease of the legs at the stage of intermittent claudication. Report of 100 cases (author's transl)].

100 patients with stage II arteritis (claudication alone) were operated on. In the vast majority of cases (78%), the lesions were aorto-iliac. The operative mortality was nil. The immediate follow up period included 2 thromboses requiring 2 reoperations. The long term follow up, on average 22 months (from 8 months to 3 years) was very satisfactory with a good functional result in 94.5% of cases. We noted 4 deaths, of which 3 were of cardiovascular origin, 4 secondary thromboses of which 2 were due to suddenly stopping anticoagulants. The low morbidity is a further reason for early surgery, as it is known that the risks of operation at a later stage, e.g. stages III and IV, may occur suddenly in the course of an apparently stable arteritis.

Adult↗
PubMed1988

Double-blind placebo-controlled trial of buflomedil in intermittent claudication.

In a double-blind placebo-controlled trial, buflomedil was shown to cause a significant increase both in median claudication provoking time from 63 sec (range: 24-136 sec) to 124 sec (range: 53-261 sec) (p less than 0.01), and in maximum walking distance (MWD) from 169m (range: 157-308 m) to 293 m (range: 107-429 m) (p less than 0.01). The MWD after three months' buflomedil treatment was also significantly (p = 0.05) prolonged when compared with the MWD in the appropriate placebo group. In contrast, treatment with the placebo caused no significant change in these indices. Subjective improvement was observed in 12 out of 14 patients on buflomedil, whilst it occurred in only 6 out of 14 patients on the placebo (p less than 0.05). The clinical improvement was not associated with an increase in the ankle pressure index or a reduction in platelet aggregation and thromboxane A2 release.

Aged↗
PubMed1990

[Acral skin circulation following intra-arterial infusion of vasodilating substances in patients with intermittent claudication].

The value of vasodilator drugs for the conservative treatment of peripheral arterial occlusive disease is widely questioned because clinical and experimental studies have shown paradoxical redistribution phenomena of blood flow in disfavour of an already ischemic peripheral circulation. This paper deals with acute effects of intraarterially infused prostaglandin E1 and buflomedil on the overall foot sole perfusion as well as its distribution patterns. Measurements were performed in patients with sufficiently compensated obstructions of the superficial femoral artery by means of dynamic fluorescein angiography. After i.a. infusion in general an increase of the total blood supply to the feet was found. However, in response to this common vasodilator effect in some patients apparently non-perfused circumscribed skin areas occurred which could never be observed under control conditions. With respect to these results the clinical value of vasodilator drugs as well as the meaning of such adverse redistribution phenomena are discussed from a pathophysiological and pharmacodynamical point of view. It is proposed that the therapeutical concept of pharmacological vasodilation should not be rejected in general. However, special attention should be paid to the development of steal effects.

Aged↗
PubMed1999

Randomized reliability study evaluating constant-load and graded-exercise treadmill test for intermittent claudication.

The aim of this randomized study was to compare the reliability of the treadmill test at constant-load (C-test, 3 km/hr; fixed grade of 12%) recommended in Germany with that of the graded-exercise test (G-test, 3 km/hr; increase in grade of 3.5% every 3 minutes) propagated in the United States. In 50 patients with an absolute claudication distance (ACD) in the C-test of between 50 and 400 m, the two treadmill tests were carried out in randomized order on one and the same day, and repeated on 3 days within 1 week. For the initial claudication distance (ICD), the intraclass correlation was 0.88 in the C-test and 0.87 in the G-test. For the ACD the coefficients were identical at 0.91. The within-subject variation (CVwithin) in the C-test and G-test was 25% and 27% for the ICD and for the ACD 24% and 21%, respectively. The between-subject variation was very similar with 72% and 73% (ICD) and with 78% and 68% (ACD). However, in ACDs below 100 m and between 100 to 150 m, the C-test showed significantly smaller coefficients of variation than the G-test: 13% vs 81% and 14% vs 50%, respectively. In conclusion, the results showed that both C-test and G-test are equally well reproducible.

Analysis of Variance↗
PubMed2002

Management of intermittent claudication.

Medical management of PAD is a considerable challenge. Although patients typically present with IC, there is a substantial pool of subclinical PAD patients. PAD, whether symptomatic or not, confers a marked cardiovascular risk; with affected patients dying of heart attack or stroke, identification of index patients and aggressive medical treatment can offer health benefits far in excess of improvement in IC or related symptoms. Management of risk factors, lifestyle interventions, and pharmacologic treatment with agents to provide symptomatic relief have a central role in improving function and quality of life and slowing the progression to advanced endpoints, such as the rest pain, nonhealing ulcers, gangrene, and cardiac death. Surgical or percutaneous revascularization for aorto-iliac disease provides durable treatment for individuals with disabling symptoms. Newer treatments, such as angiogenic growth factor treatments, are being tested in clinical trials and seem promising. There are limited treatment choices for individuals with predominant infra-popliteal disease. In the future, the availability of newer stents and therapies to prevent re-stenosis may extend the applicability of endovascular treatment to difficult-to-treat infra-inguinal lesions.

Disease Susceptibility↗
PubMed1988

[Intra-arterial infusion treatment with prostaglandin E1 in patients with intermittent claudication].

In a double-blind, placebo-controlled study 50 patients with peripheral arterial occlusive disease stage IIb were given daily or intra-arterial infusion of either 1 ampoule of Prostavasin (20 micrograms PGE 1) or 1 ampoule of placebo (646.7 micrograms alpha-cyclodextrin), each dissolved in 50 ml saline, over 60-120 min. Weekends excepted, the therapy was continued for three weeks. Under PGE 1 therapy the maximum ergometric walking distance increased by 146% (mean: from 109 m to 268 m), as opposed to 40% in the placebo group (mean: from 101.5 m to 142 m). Furthermore, significant improvements were seen with regard to painfree walking capacity (PGE 1: + 170%; placebo: + 49%). Free maximum and pain-free walking distances were increased as well (PGE 1: + 131% and 48%; placebo: + 26% and 27%). Haemorrheological parameters, e.g. plasma and whole blood viscosity, haematocrit and erythrocyte aggregation decreased (p less than 0.01) after PGE 1, whereas a significant increase (p less than 0.01) in acral digital temperature, blood flow and ultrasonic Doppler values was seen. No side-effects were observed.

Alprostadil↗
PubMed1978

Lower leg blood flow in intermittent claudication.

Lower leg blood flow was measured at rest and both during and after graduated bicycle exercise in five healthy men and in seventeen patients suffering from various degrees of obliterating arteriosclerosis of the lower limbs. A thermodilution technique was used for flow determinations. The subject exercised in the sitting position and the work load was increased stepwise from a starting load of 100 kpm/min (100 kpm/min load increment every second minute until exhaustion). Three flow phases were depicted during and after the exercise: the aerobic phase, the phase of relative ischaemia and a postexercise phase. During exercise, lower leg blood flow increased approximately twenty times in healthy subjects, while in the arteriosclerotic subjects there was a two-fold to ten-fold increase in flow. In patients with serious distal and proximal stenoses a proximal steal phenomenon was demonstrated during submaximal and maximal exercise. A close correlation was found between maximum individual work load capacity and maximum lower leg blood flow (r = 0.71, P less than 0.001). In the patient group lower leg blood flow at a certain work load was 45% (P less than 0.001) higher in the sitting than in the supine position.

Adult↗
PubMed1992

[Gingko biloba extract EGb 761 and pentoxifylline in intermittent claudication. Secondary analysis of the clinical effectiveness].

Clinical trials on the efficacy of EGb 761 and pentoxifylline are summarized in the context of their methods and results and compared with each other. All placebo-controlled, randomized and double-blind studies with the major target objective of "pain-free walking distance" were selected. The pentoxifylline studies were adopted from a survey of the existing literature in the English language, which has been brought up to date via DIMDI research. The studies on both active substances are fraught with similar difficulties as to method, and are not different as regards their quality. The increase in walking distance is highly variable, especially in the pentoxifylline studies. On average through each and all of the studies on both preparations, an increase of 45% (EGb 761) or 57% (pentoxifylline) in relation to initial values is here found. No differences in the documentation of efficacy and the clinical efficacy were discovered between the two substances, both of which are registered as effective substances in the treatment of peripheral arterial occlusion (pAO) in accordance with the Federal German Drugs Law (Arzneimittelgesetz, AMG) of 1976.

Dose-Response Relationship, Drug↗
PubMed1993

[Neurogenic intermittent claudication of the femoral nerve caused by occlusion of the common iliac artery].

A 52 year old heavy smoker complained of paresthesiae and pain at the ventral side of the right thigh and the antero-medial side of the right lower leg as well as weakness of the right quadriceps femoris during exercise. Clinical examination revealed a paresis of the right quadriceps, hypesthesia and hypalgesia in the area of the femoral nerve and a reduced right patellar reflex after 10 min walking. An occlusion of the right common iliac artery was diagnosed by angiography. Following transluminal angioplasty and implantation of an intravascular stent, the patient was free of symptoms. On the basis of the clinical observations following recanalisation of the common iliac artery, the symptoms can best be explained by a reduced perfusion of the iliolumbar artery supplying the upper part of the femoral nerve, causing ischemia of the femoral nerve during exercise. In conclusion, stenosis/occlusion of the common iliac artery should be considered as a differential diagnosis of quadriceps weakness and paresthesia in the area of the femoral nerve associated with exercise.

Angiography, Digital Subtraction↗
PubMedDate not supplied

[The soleus syndrome. Apropos of 3 cases of intermittent claudication of venous origin].

UNLABELLED: The typical case present with a unilateral, atypical claudication with discrete oedema, occurring after repeated exercise. These paradoxical features of venous pain, aggravation with attacks, resolution after prolonged rest and the absence of arterial signs are suggestive of the disease. The syndrome may present as repeated calf thromboses or recurrent varicose veins suggesting some deep obstruction. An inflammatory and oedematous process linked to exercise is associated with a congenital predisposition: a constriction of the venous arcade at the insertion of the soleus. Phlebography confirms the absence of thrombophlebitis and shows underlying stasis and poor opacification of the deep popliteal and, most importantly, anterior hooking and actual kinking of the vein on the lateral film which persists on mild flexion. A simple surgical procedure to free the vein turns this incapacitating and potentially thrombogenic pathology into a benign condition. TITLE: Therapeutic modalities for ischaemic atrophy in its acutely painful phase or the exceptional use of corticotherapy in phlebology.

Adolescent↗
PubMed2006

A pilot study of ranolazine in patients with intermittent claudication.

AIM: This pilot study provides preliminary information regarding safety and changes in exercise performance during treatment with ranolazine extended-release in patients with reproducible claudication during exercise treadmill testing (ETT). METHODS: We enrolled 45 patients with documented peripheral arterial disease, reproducible claudication on ETT, and ankle-brachial indices <0.85 at rest that decreased by at least 0.15% or 20% immediately postexercise. Randomized patients received double-blind treatment with either ranolazine 1 000 mg b.i.d. (n=22) or placebo (n=23) for 4 weeks. RESULTS: Compared with baseline, peak walking time (PWT) increased (mean+/-SEM) by 53+/-34 s with ranolazine (P=0.13) and by 41+/-33 s with placebo (P=0.22). Pain-free walking time during ETT increased by 62+/-18 s with ranolazine (P=0.002) and 36+/-18 s with placebo (P=0.045). Supplemental analyses, excluding patients with baseline exercise duration (16 min and (12 min, showed additional improvement with ranolazine on PWT. CONCLUSIONS: Ranolazine was well tolerated and these data provide a rationale for proceeding with a definitive trial.

Acetanilides↗
PubMed1975

Effect of a proteinase inhibitor on intermittent claudication or on pain at rest in patients with peripheral arterial disease.

Twenty patients with peripheral arterial disease and 10 normal controls were submitted to i.v. injection of aprotinin, polypeptide (mol.wt. 6512) extracted from bovine lung, in order to examine its effects on: (a) lower limbs pain, (b) lower limbs sensibility, (c) calf blood flow. Aprotinin (100,000 Ku i.v. diluted in NaCl 0.9%) was given in a single dose or twice a day for a week; for control the same subject received, before or after aprotinin, an equivalent volume of diluent (0.9% NaCl). The results demonstrate that aprotinin is able to increase the initial pain limit walking tolerance and to decrease the intensity of pain at rest and of myalgic or "trigger" areas. No variation was observed on skin sensibility and on calf blood flow, both basal resting and hyperemic. The favorable effect of examined polypeptide on ischemic pain can be attributed neither to increase of calf blood flow nor to influence on perception of painful stimuli. It seems therefore to suggest that aprotinin acts on biochemical mechanisms that cause the ischemic pain. Presumably it inhibits kininogenases and tissue protein-hydrolyzine enzymes activated in the course of ischemia.

Adult↗
PubMed2006

Treating intermittent claudication with Tibetan medicine Padma 28: does it work?

Herbal drugs are being increasingly used in medical practice, often without appropriate scrutiny of their safety and efficacy. The medicinal product Padma 28 is a fixed combination with Tibetan origin, used in Europe since the 1960s for the symptomatic treatment of circulatory disorders, including those of peripheral arterial occlusive disease (PAOD). We have conducted an analysis of all available data on this herbal drug from published literature as well as from original data we obtained from contacting the authors of published papers, reports and the manufacturer. A total of 19 trials have reported on 2084 patients to date, 444 of whom were in six controlled clinical studies on PAOD. A meta-analysis of five trials showed Padma 28 to increase walking distance by >100m in 18.2% of the patients with verum, versus 2.1% with placebo (P<0.001; odds ratio: 10 [95% CI 3.03, 33.33]; RR: 0.12; number needed to treat=6.2). The safety profile appears to be favourable. Available evidence shows that Padma 28 provides significant relief from PAOD-related symptoms (i.e. walking distance), probably of the same order of magnitude as other employed medications. However, larger confirmatory RCTs are desirable.

Humans↗
PubMed2006

Blood pressure in patients with intermittent claudication increases continuously during walking.

OBJECTIVES: The purpose of this study was to compare the circulatory responses to walking in patients with peripheral atherosclerotic disease (PAD) and healthy controls. METHODS: The participants were eleven patients with diagnosed PAD, and a control group of six healthy age-matched adults. Blood pressure, heart rate (HR), and acral skin perfusion were recorded continuously before, during and after a walking exercise on a treadmill. RESULTS: The patients walked to maximum claudication distance (MCD) on a treadmill, median walking distance 103 (34-223) metres [median (range)], at 3.3 (1.0-4.5) km/h. There was a steep increase in HR and mean arterial pressure (MAP) while the patients were walking. At claudication the median rise in MAP was 46.6 (10.3-61.3) mmHg, systolic blood pressure (SP) increased by 84.9 (31.4-124.9) mmHg, and diastolic blood pressure (DP) by 21.7 (-2.1-31.7) mmHg. HR increased by 34.9 (12.9-48.1) beats/min. The control group walked for 5 minutes at 3.2 (3.0-3.3) km/h. In the control group the blood pressure initially increased moderately but stabilised thereafter. Median rise in MAP during walking was 8.5 (5.6-14.6) mmHg, SP increased by 30.9 (6.6-41.5) mmHg, and DP was reduced by -1.4 (-5.4-1.5) mmHg. HR increased by 27.1 (18.8-34.9) beats/min. We found no significant differences in acral skin perfusion during walking exercise between the patients and control group. CONCLUSIONS: In patients with PAD, blood pressure increased continuously and significantly when walking to MCD (dynamic exercise). The level of increase in blood pressure was similar to that caused in response to isometric exercise.

Aged↗