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Results for “INTERMITTENT CLAUDICATION”

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At least 1,441 records · Page 80Linked to original sources
PubMed1986

Increased red blood cell deformability due to isoxsuprine administration decreases platelet adherence in a perfusion chamber: a double-blind cross-over study in patients with intermittent claudication.

Platelet transport towards the vessel wall is influenced by the hematocrit, red blood cell (RBC) size, and shape. Recent in vitro studies have indicated that RBC deformability may also influence platelet transport. The observation that isoxsuprine, a known vasodilating drug, caused increased RBC deformability in vitro and decreased platelet transport in vitro prompted us to study the effects of this drug in vivo. The study was performed in a double-blind cross-over study of isoxsuprine v placebo in ten patients with peripheral arterial insufficiency. RBC deformability was estimated from viscosity measurements using the blood viscosity equation of Dintenfass and expressed as T value. Platelet transport was studied in an annular perfusion chamber according to Baumgartner. Human umbilical arteries were used as blood vessels. Perfusion studies were performed with whole blood or with RBCs of the patients mixed with normal platelets and plasma at a standardized hematocrit and platelet count. An increase in RBC deformability concomitant with a decrease in platelet adherence was observed in patients on isoxsuprine with a drop in T value of approximately 0.06 (from 0.91 toward 0.86), and a concomitant decrease in platelet adherence of 20% to 40%. These observations differed significantly from the results in the placebo group and showed a significant group-period interaction at the cross-over of medication (analysis of variance). The effects on platelet adherence were observed at high vessel wall shear rate (1,800 s-1) with perfusates consisting of patients' RBCs and donor plasma and platelets at standardized hematocrit and platelet count. No differences were observed under these conditions at a shear rate of 300 s-1. When whole blood of patients was used, nonsignificant effect was observed at shear rates of 300 s-1 and 1,800 s-1. This was probably caused by the added noise due to variations in hematocrit and platelet number. These data demonstrate that isoxsuprine increases RBC deformability, and they suggest the possibility of decreasing platelet-vessel wall interaction in vivo by manipulation of RBC deformability.

Adult↗
PubMed1978

Neurogenic and vascular claudication.

Intermittent claudication from peripheral vascular disease is sometimes difficult to distinguish from similar claudication due to degenerative disease of the lumbar spine. In the present study 26 patients with vascular disease were compared with 23 patients with lumbar degenerative disease. Assessment was by clinical and radiological examination. In the vascular group characteristic distinguishing features were: abnormal foot pulses, arterial bruits, relief of symptoms by standing, a constant claudicating distance and stocking sensory loss. In the lumbar group typical findings were: discomfort on lifting, bending, coughing or sneezing, pain on standing, history of back injury, variable claudicating distance and segmental sensory loss.

Aged↗
PubMed1997

Role of revascularization in the treatment of claudication.

Intermittent claudication is a relative indication for vascular reconstruction. Conservative management with a combination of risk factor control, exercise training and medical therapy will relieve or at least improve claudication in some patients. If claudication precludes gainful employment or imposes an unacceptable alteration in lifestyle, surgical revascularization should be considered. Surgical bypass for claudication will produce optimal results in younger patients, in whom near-normalization of the ankle/brachial index can be anticipated. Proximal axial (in-line) reconstructions maintain their patencies longer than more distal, and often technically more challenging, bypasses. These tenets also apply well to percutaneous transluminal angioplasty. Both surgical and catheter-based interventions carry potential risks of short- and long-term morbidity, although overall morbidity associated with surgery for claudication is acceptably low. Interventions are justified only if they are safe, effective and durable, and if they are performed after the long-term prognosis for both life and limb is considered.

Anastomosis, Surgical↗
PubMed2001

Interplay between inhibition of adenosine uptake and phosphodiesterase type 3 on cardiac function by cilostazol, an agent to treat intermittent claudication.

The authors have recently shown that cilostazol, a type 3 cyclic nucleotide phosphodiesterase (PDE3) inhibitor, has a much weaker positive inotropic effect than milrinone, a PDE3 inhibitor of similar potency. They have also shown that cilostazol inhibits adenosine uptake, whereas milrinone has no such effect. This study investigated the possible cardiac functional significance of cilostazol on adenosine uptake inhibition. In isolated rabbit hearts, 10 microM of cilostazol elevated adenosine concentration in interstitial dialysate (0.16 +/- 0.01 microM, or approximately 0.81 microM in the interstitial space when adjusted for recovery rate of microdialysis) and coronary effluent (0.69 +/- 0.03 microM ). The values are significantly higher than those for 10 microM of milrinone (0.11 +/- 0.1 microM in interstitial dialysate and 0.2 +/- 0.04 microM in coronary effluent). Although cilostazol increased contractility, heart rate, and coronary flow in isolated rabbit hearts, the effect on contractility and heart rate was significantly augmented in the presence of an adenosine A 1 receptor antagonist. Conversely, an adenosine A 1 receptor agonist or an adenosine uptake inhibitor attenuated the positive inotropic effect of milrinone. These results indicate that adenosine uptake inhibition by cilostazol increases interstitial and circulatory adenosine concentration, and antagonizes PDE3 inhibition-induced contractility and heart rate increases through an adenosine A 1 receptor-mediated mechanism.

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMed1978

Rheumatoid arthritis contributing to lumbar spinal stenosis. Neurogenic intermittent claudication.

Two patients with rheumatoid arthritis affecting the lumbar spine showed the clinical, roentgenological, and operative characteristics of lumbar spinal stenosis, which is a neurological complication of rheumatoid arthritis that can be treated by surgery. The clinical history is a prerequisite for suspicion of the syndrome, and lumbar myelography including roentgenograms of the extended lumbar spine may verify the diagnosis.

Arthritis, Rheumatoid↗
PubMed1998

Gait characteristics of patients with claudication.

OBJECTIVE: Intermittent claudication of the lower extremity vessels produces pain during walking. This study differentiates walking patterns of patients with claudication from walking patterns of healthy individuals. DESIGN: Nonrandomized case control study performed in a teaching university hospital outpatient setting. PATIENTS: The sample of convenience involved male patients with lower extremity claudication (n = 19) and 11 healthy men of similar ages. INTERVENTIONS: Subjects were asked to walk at self-selected speed for 20 meters on a level, indoor surface. OUTCOME MEASURES: Walking velocity and number of steps were averaged over each of five trials, and step length was calculated from these measures. RESULTS: Patients with claudication walked slower and had decreased step length and decreased cadence compared with controls (p < .001). No positive relationship was found between disease severity, peak walking time, and step length, cadence, or speed. CONCLUSION: All patients with claudication, regardless of disease severity, demonstrated abnormal gait parameters compared with controls. Further studies should evaluate whether the abnormal gait parameters significantly curtail walking ability.

Aged↗
PubMed1983

Pressured pattern or type A behavior in patients with peripheral arteriovascular disease: controlled retrospective exploratory study.

The question as to whether a specific behavior or type A pattern is limited to patients with coronary artery disease, or is found in atherosclerotic disease, in general, is explored. The interrelationship between a pattern of "pressured" behavior, assessed by open ended interviews, type A behavior, determined by the Bortner test, and peripheral atherosclerotic disease was investigated in a controlled retrospective study which compared three groups of 13 patients each: intermittent claudication (IC), intermittent claudication combined with coronary artery disease (CADIC) and a control group of patients without vascular disease (WVD). A pressured behavior pattern, assessed by interview, was found to be most prominent in the CADIC group, and least in the control group. The subjects with arteriovascular disease tended to exert more control over people compared to the WVD patients (Fisher's exact probability test, p = 0.05). The tendency to type A behavior, measured by means of the Bortner scale, also differentiated the three groups with CADIC scoring highest and WVD scoring lowest (analysis of variance, F = 3.944, p less than 0.05). IC patients present personality features of proneness to coronary disease. The pattern of "pressured" and type A behavior seem to correlate with the number of vascular areas involved in atherosclerotic disease.

Coronary Disease↗
PubMed1992

[The fate of patients with intermittent claudication-comparison of surgical and non-surgical treatment].

The purpose of this study was to determine the operative indication for patients with intermittent claudication because of arteriosclerosis obliterans, and to compare the late result of the surgical treatment group (182 cases, 250 limbs) with that of the non-surgical treatment group (35 cases, 43 limbs). There were 3 operative deaths and 34 late deaths in the surgical group, and 14 late deaths in the non-surgical group. The number one cause of death was heart failure, including ischemic heart disease, in both groups. The 4-year cumulative patency rates were 91% in the aorto-iliac, 71% in the femoro-distal and 79% in the aorto-femoro-distal arterial reconstructions. Long term symptom free rates of the surgical group and the non-surgical group, except fatal case, were 83% and 44% in the aorto-iliac, 79% and 27% in the femoro-distal, 87% and 33% in the aorto-femoro-distal arterial regions, respectively. Late result of intermittent claudication in the surgical group was better than that in the non-surgical group. We concluded that intermittent claudication should be considered to be the indication for surgery, except for the cases with high risk diseases or malignant diseases.

Aged↗
PubMed1987

[Intermittent venous claudication: a rarely diagnosed walking disability].

Intermittent venous claudication occurs mostly in young, physically active people after iliac vein thrombosis. In 20 healthy volunteers and 4 patients with venous claudication, plethysmographic volume measurements of the thigh and calf were made during treadmill work (10 degrees gradient, 7 km/h). The mean volume of the calf in the 20 healthy controls decreased at the beginning of exercise, climbed again later and reached a plateau after 100 sec, indicating a balance between arterial inflow and venous drainage. In the 4 patients with status after iliac vein thrombosis the volume of the affected leg rose continuously during exercise without reaching a plateau, until leg pain forced the patient to stop. The measured volume of the affected leg at the point of pain was higher than that of the patients' contralateral leg and higher than that of the controls (p less than 0.01). Strain-gauge plethysmography during treadmill work permits non-invasive, objective diagnosis of the venous drainage abnormality that leads to intermittent venous claudication.

Adult↗