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Results for “INTERMITTENT CLAUDICATION”

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PubMed2003

Effect of beta-blockers on peripheral skin microcirculation in hypertension and peripheral vascular disease.

OBJECTIVE: This study was undertaken to investigate the possible negative effect of beta-blockers on skin microcirculation in patients with intermittent claudication and hypertension. Methods and materials In this clinical crossover study, 20 patients with mild to moderate hypertension, treated with long-term beta-blockade, and intermittent claudication or ischemic rest pain, underwent assessment of peripheral circulation before and after 2-week withdrawal of beta-blocking therapy and again 2 weeks after restarting therapy. Replacement therapy (calcium antagonist) was given if considered necessary to control hypertension. Skin microcirculation was assessed with three noninvasive techniques: capillary microscopy of the hallux nailfold, transcutaneous oximetry of the forefoot, and laser Doppler fluxmetry of the great toe. RESULTS: Mean initial blood pressure was 163/81 mm Hg. Mean heart rate significantly increased with withdrawal of beta-blocker, from 65 bpm to 85 bpm. No significant differences in skin microcirculation and blood pressure were found between measurements obtained before, during, and after withdrawal of beta-blocking therapy. Patients experienced no change in symptoms during the study. CONCLUSION: beta-Blockers do not appear to have a negative effect on peripheral skin microcirculation and are therefore not contraindicated to treat hypertension when intermittent claudication or ischemic rest pain is also present.

Adrenergic beta-Antagonists↗
PubMed1994

Cross-sectional area of the stenotic lumbar dural tube measured from the transverse views of magnetic resonance imaging.

The cross-sectional area of the lumbar dural tube was calculated from transverse-slice lumbosacral magnetic resonance images (MRI) using the simple geometric formulas and computerized digitizer in 51 patients with low-back pain only, 79 with mainly radicular symptoms, and 53 with intermittent claudication, and in 39 controls with confirmed symptomatic lesions at a nonlumbar level or of a nonspinal organ. Findings suggesting developmental narrowing of the spinal canal were found not only in the intermittent claudication group, but also in the radicular pain group. Cross-sectional area of < 100 mm2 at more than two of three (L2/3, L3/4, and L4/5) intervertebral levels was highly associated with the presence of intermittent claudication. The cross-sectional area value obtained with the simplified geometric formulas was highly correlated with that calculated with the digitizer, indicating that this simple method can be used with MRI in outpatient clinics for the rapid determination of the most stenotic portion of the dural tube.

Adolescent↗
PubMed1994

Risk factors for atherosclerotic cardiovascular outcomes in different arterial territories.

BACKGROUND: The major cardiovascular risk factors adversely affect all vascular territories, increasing the vulnerability to multiple clinical manifestations of atherosclerosis. PATIENTS: The population at risk was the Farmingham cohort of 5209 men and women assessed bienially for the development of overt events of coronary heart disease (CHD), congestive heart failure, intermittent claudication, and atheroembolic brain infarction. RESULTS: In persons younger than 65 years, all the major risk factors were found to impact significantly on the incidence of coronary heart disease and intermittent claudication. For stroke and cardiac failure, all but the serum cholesterol level were important. In those older than 65 years, serum total cholesterol levels and smoking no longer influenced the incidence of coronary heart disease. The ratio of total- to high-density-lipoprotein-cholesterol levels, however, was related to all cardiovascular outcomes except stroke at all ages. The impact of cigarette smoking on stroke and intermittent claudication persisted in advanced age. CONCLUSION: Modification of risk factors for the purpose of preventing a particular cardiovascular event should also prevent other outcomes. The impact of any particular risk factor on any atherosclerotic cardiovascular disease outcome is profoundly influenced by the frequent coexistence of other risk factors. A correct appraisal of the hazard and urgency for treatment is best obtained from a cardiovascular risk profile estimating the conditional probability of an event given the existing constellation of factors.

Adult↗
PubMed1993

Disodium-ethylene diamine tetraacetic acid (EDTA) has no effect on blood lipids in atherosclerotic patients. A randomized, placebo-controlled study.

OBJECTIVE: To study whether intravenous disodium-ethylene diamine tetraacetic acid (EDTA) affects blood lipids in patients with intermittent claudication. DESIGN: Double-blind, randomized, placebo-controlled trial. PARTICIPANTS: Twenty-nine patients with intermittent claudication (systolic ankle-brachial blood pressure index < 0.8; pain free walking distance 50-200 m). INTERVENTION: 3 g EDTA or placebo (isotonic saline) per infusion over a period of 5-9 weeks to a total of 57 g EDTA. Patients received vitamins, minerals and trace-elements daily. RESULTS: 14 patients received EDTA and 15 placebo. There was no statistically significant difference in the plasma concentration of cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol or triglyceride between the 2 groups. CONCLUSION: Treatment with EDTA does not alter blood lipids in patients with intermittent claudication.

Adult↗
PubMedDate not supplied

Gadolinium magnetic angioresonance in the study of aortoiliac disease.

There is a need for noninvasive methods for the early identification of patients with intermittent claudication who need surgical treatment. Newer magnetic resonance angiography (MRA) techniques allow detailed study of the arterial tree with image quality similar to that of conventional arteriography. From April 1997 to January 2001, 30 patients with intermittent claudication of the lower limbs were studied with both imaging methods. In each case, the MRA images were examined first and the arteriographic images were examined 15 days later. Examiners interpreting the arteriographic images were blinded to the results of the corresponding MRA images. After each examination (MRA and arteriography), a vascular surgeon suggested a surgical plan. MRA showed results similar to those of arteriography, although with inferior image quality. No patient had an allergic reaction or side effects due to administration of contrast material. There was total agreement between MRA and arteriography in regard to the morphologic analysis and proposed surgical plans in every case. In conclusion, MRA is a feasible, useful, and less invasive alternative for the morphologic evaluation of the aortofemoral area in patients with intermittent claudication of lower limbs.

Adult↗
PubMed2006

The conundrum of claudication.

Stable claudication has traditionally been treated conservatively by many clinicians as operative therapies involve considerable risk for a condition that is often slowly progressive and non-fatal. The relative safety of less invasive endovascular techniques brings potential survival benefits from the increased exercise tolerance that result. We aimed to revisit and clarify the aetiologies of intermittent claudication in a review of the rarer causes that can mimic atherosclerotic occlusive disease. An extensive search of Medline, Embase and the Cochrane databases was carried out to compile published work addressing the aetiology of claudication and specific non-atherosclerotic causes. The reference lists of these manuscripts were also searched for relevant articles. There are several vasculogenic and neurogenic causes for intermittent claudication, many of which are unrelated to atherosclerosis. Recognition of these rarer syndromes is essential when planning endovascular or operative management strategies. Consideration of non-atherosclerotic differential diagnoses is recommended when assessing the patient with intermittent claudication. This is particularly critical in the young patient whose pattern of symptoms and risk factors may not fit precisely with atherosclerosis.

Adult↗
PubMedDate not supplied

[Peripheral vasodilators: from the hemodynamic effect to clinical benefit].

Patients with chronic occlusive arterial disease of lower limbs have an excess mortality due to associated cardiovascular diseases or cancer. They also have an important morbidity with a high prevalence of coronary artery diseases and strokes. In this context, the only benefit of peripheral vasodilators devoid of any effect on morbidity and mortality, could be only on quality of life. Haemodynamic effects of these drugs have been evaluated by several reproducible techniques in order to measure the peripheral blood flow (plethysmography, 133Xe clearance, transcutaneous oxygen-pressure, electromagnetic debimetry). An increase in blood flow has been demonstrated in patients receiving pentoxifylline, naftidrofuryl, or blufomedil in phase II clinical trials using these different methods. No general haemodynamic effect has been observed with these drugs which were better denominated vaso-active drugs. However the most relevant criteria remained to confirm a clinical benefit, particularly on intermittent claudication. Number of positive clinical trials in patients with intermittent claudication have been published, but from a methodological point of view few of them were suitable and demonstrated a statistically significant benefit. Criticisms were mainly related to the type of trial (cross-over is not recommended because of the drug-period effect), the lack of 'intention to treat' analysis, the inhomogeneity of the compared groups (for example different percentages of diabetics and excess of drop-outs). In spite of an established haemodynamic effect and of a demonstrated benefit in claudicants, peripheral vasodilators appear to have a slight interest in the global care of patients with occlusive arterial disease of lower limbs mainly on functional symptoms.

Clinical Trials as Topic↗
PubMed1999

Cilostazol.

Cilostazol is an antiplatelet agent with vasodilating properties that has been used in the treatment of patients with peripheral ischaemia such as intermittent claudication. The drug inhibits platelet aggregation induced by ADP, collagen and arachidonic acid. Unlike aspirin (acetylsalicylic acid), cilostazol inhibits both primary and secondary aggregation. It also acts as a vascular vasodilator by inhibiting calcium-induced contractions while having no direct effect on contractile proteins. In double-blind randomised trials, patients with intermittent claudication receiving cilostazol showed significant improvements versus placebo in terms of time to initial pain and maximal walking or absolute claudication distance; these findings were confirmed by cilostazol patients' positive responses on subscales measuring physical functioning and quality of life. In a 24-week randomised double-blind trial in patients with intermittent claudication, cilostazol 100mg twice daily produced significant improvements in pain-free and maximum walking distances, compared with pentoxifylline (oxpentifylline) 400mg 3 times daily and placebo. Cilostazol has been well tolerated, with the most common adverse events being headache, diarrhoea, abnormal stools and dizziness.

Cilostazol↗
PubMed2005

Complementary therapies for peripheral arterial disease: systematic review.

While peripheral arterial disease (PAD) affects a considerable proportion of patients in the primary care setting, there is a high level of use of complementary treatment options. The aim was to assess the effectiveness of any type of complementary therapy for peripheral arterial disease. A systematic review was performed. Literature searches were conducted on Medline, Embase, Amed, and the Cochrane Library until December 2004. Hand-searches of medical journals and bibliographies were conducted. There were no restrictions regarding the language of publication. The screening of studies, selection, data extraction, the assessment of methodologic quality and validation were performed independently by the two reviewers. Data from randomized controlled trials, and systematic reviews and meta-analyses, which based their findings on the results of randomized controlled trials were included. Seven systematic reviews and meta-analyses and three additional randomized controlled trials met the inclusion criteria and were reviewed. The evidence relates to acupuncture, biofeedback, chelation therapy, CO(2)-applications and the dietary supplements Allium sativum (garlic), Ginkgo biloba (ginkgo), omega-3 fatty acids, padma 28 and Vitamin E. Most studies included only patients with peripheral arterial disease in Fontaine stage II (intermittent claudication). The reviewed RCTs, systematic reviews and meta-analyses which based their findings on the results of RCTs suggest that G. biloba is effective compared with placebo for patients with intermittent claudication. Evidence also suggests that padma 28 is effective for intermittent claudication, although more data are required to confirm these findings. For all other complementary treatment options there is no evidence beyond reasonable doubt to suggest effectiveness for patients with peripheral arterial disease.

Arteries↗
PubMed1997

Blood flow rate during orthostatic pressure changes in the pulp skin of the first toe.

OBJECTIVES: Determination of the local regulation of cutaneous blood flow through nutritive capillaries and through arteriovenous anastomoses of the pulp of the first toe in response to passively induced orthostatic blood pressure changes in normal subjects and in patients with occlusive atherosclerotic disease. MATERIAL: Six normal subjects, seven patients with unilateral, crural intermittent claudication and six patients with unilateral, chronic critical ischaemia. METHODS: Blood flow rates were measured in supine subjects by the heat washout method (the sum of blood flow rate in arteriovenous anastomoses and blood flow rate in nutritive capillaries) and by the 133Xenon washout method (blood flow rate in nutritive capillaries) after local, atraumatic labelling. Measurements were made with (a) the toe passively elevated to 50 cm above heart level, (b) at heart level and (c) passively lowered to 50 cm below heart level. RESULTS: Autoregulation of nutritive blood flow was present in normal subjects and in claudicants, but the local sympathetic veno-arteriolar axon reflex was absent in both groups. In patients with critical ischaemia blood flow rate was the same in the supine position and during lowering in arteriovenous anastomoses and in nutritive capillaries. The arteriovenous anastomoses had distinct and characteristic reaction patterns in response to lowering in each of the three examined groups and to elevation in normal subjects and in patients with intermittent claudication (not measured in patients with critical ischaemia). CONCLUSIONS: The microvascular responses to changes of orthostatic blood pressure differed among the three groups (normal subjects, patients with intermittent claudication, patients with critical chronic leg ischaemia). The heat washout method may be used to detect the functional significance of occlusive atherosclerotic disease.

Adult↗
PubMed1993

[Treatment of diabetic arteriopathy. Importance of transluminal angioplasty].

Results are reported of a retrospective analysis of transluminal angioplasty (TLA) interventions in 20 diabetic patients, 16 men and 4 women, mean age 56 years (range 32 to 82 years), with 24 dilated lesions, 16 patients having insulin-dependent diabetes. In 12 cases the lesions were at the intermittent claudication stage, trophic lesions being present in 8 cases. Stenotic lesions were iliac (12 cases), superficial femoral (2 cases), popliteal (6 cases) and tibial (4 cases). One patient developed an acute occlusion following popliteal-anterior tibial recanalization, the only direct complication of the angioplasty. Angiography showed immediate satisfactory results in 22 of the 24 dilated lesions. Functional and hemodynamic improvement was a constant finding in patients with intermittent claudication, trophic lesions being healed in 4 cases (50%) the other patient showing either no change or requiring an unavoidable amputation (2 cases). These overall findings suggest that at the intermittent claudication stage no differences exist in the results of TLA when compared with a non diabetic population; inversely, in the presence of trophic disorders, the local conditions (distal bed, infection, gangrene) interfere considerably in the course of the dilatation. Transluminal angioplasty should therefore be carried out as early as possible in diabetics; arteriography should be performed as soon as even minimal claudication appears and, a fortiori, even at the onset of a trophic lesion.

Adult↗