Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “INTERMITTENT 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 1,567 records · Page 87Linked to original sources
PubMed2001

[Treatment of chronic arterial occlusive disease of the lower limbs with propionyl-1-carnitine in elderly patients].

BACKGROUND: Atherosclerosis is the most common pathology affecting the arterial system in elderly patients and arterial occlusive disease of the lower limbs represents one of the most severe complications. Intermittent claudication is the clinical expression of the ischemia underlying this arterial disease. Patients suffering from this complication present altered homeostasis of carnitine that results, by means of various mechanisms, in an alteration of the oxidative processes and damages the oxidative phosphorylation of the skeletal muscle. The effects of treatment with propionyl-l-carnitine (PLC) in a group of elderly patients with intermittent claudication (IC) are studied. METHODS: 39 elderly patients with IC were enrolled in an open study. The diagnosis was made using arterial colour ultrasonography of the lower limbs and patients were asked to perform the treadmill test. All patients received 300 mg i.v. PLC a day for 2 weeks and 1 g twice a day per os for 18 weeks. Patients presenting heart, respiratory or other problems restricting physical exercise were excluded from the study. RESULTS: After 5 months of treatment an improvement was obtained in the distance after which IC appeared (from 213+/-8 m to 357+/-13 m) and the maximum distance covered (from 307+/-12 m to 549+/-23 m). CONCLUSIONS: The results of this study allowed us to evaluate the efficacy of this drug on the severely disabling pain affecting the quality of life of patients, thus enabling the maximum distance covered by these patients to be increased. Moreover, the drug was well tolerated (only two patients reported slight collateral effects ascribed to the drug) and safe to use. It represents a valid conservative, non-surgical treatment which can be administered to all patients with intermittent claudication.

Aged↗
PubMed1990

Objectifying exercise ischemia in peripheral vascular disease: a study in 120 patients.

This study presents the results of transcutaneous oxygen pressure (TcPO2) monitoring during a treadmill test walk performed in the early stages of peripheral obliterative vascular disease. The study population consisted of a first group of 50 known arteriopathic patients presenting, on questioning, with intermittent claudication; a second group of 50 known arteriopathic patients void of any symptoms of intermittent claudication; and a third group, which was a control cohort of 20 nonarteriopathic, nonclaudicating patients. Though resting TcPO2 cannot be used to aid the clinical diagnosis of exercise ischemia it may be useful in revealing asymptomatic chronic resting ischemia (9% of cases in this series). On the other hand, a posteffort (recovery phase) fall in TcPO2 had a predictive positive diagnostic accuracy for ischemia on exercise in 99% of the cases reported here versus 87% for clinical appraisal. In the light of these results, TcPO2 measurements coupled to a treadmill test walk perfectly ascertain exercise ischemia in arteriopathic patients, whether asymptomatic or not, and avoid the false-positive results obtained by clinical evaluation.

Aged↗
PubMed1999

Diagnosis of intermittent vascular claudication in a patient with a diagnosis of sciatica.

BACKGROUND AND PURPOSE: The purpose of this case report is to illustrate the importance of medical screening to rule out medical problems that may mimic musculoskeletal symptoms. CASE DESCRIPTION: This case report describes a woman who was referred with a diagnosis of sciatica but who had signs and symptoms consistent with vascular stenosis. The patient complained of bilateral lower-extremity weakness with her pain intensity at a minimal level in the region of the left sacroiliac joint and left buttock. She also reported numbness in her left leg after walking, sensations of cold and then heat during walking, and cramps in her right calf muscle. She did not report any leg pain. A medical screening questionnaire revealed an extensive family history of heart disease. Examination of the lumbar spine and nervous system was negative. A diminished dorsalis pedis pulse was noted on the left side. Stationary cycling in lumbar flexion reproduced the patient's complaints of lower-extremity weakness and temporarily abolished her dorsalis pedis pulse on the left side. OUTCOMES: She was referred back to her physician with a request to rule out vascular disease. The patient was subsequently diagnosed, by a vascular specialist, with a "high-grade circumferential stenosis of the distal-most aorta at its bifurcation." DISCUSSION: This case report points out the importance of a thorough history, a medical screening questionnaire, and a comprehensive examination during the evaluation process to rule out medical problems that might mimic musculoskeletal symptoms.

Adult↗
PubMed2006

Peripheral vascular disease: diagnosis and treatment.

Peripheral vascular disease is a manifestation of systemic atherosclerosis that leads to significant narrowing of arteries distal to the arch of the aorta. The most common symptom of peripheral vascular disease is intermittent claudication. At other times, peripheral vascular disease leads to acute or critical limb ischemia. Intermittent claudication manifests as pain in the muscles of the legs with exercise; it is experienced by 2 percent of persons older than 65 years. Physical findings include abnormal pedal pulses, femoral artery bruit, delayed venous filling time, cool skin, and abnormal skin color. Most patients present with subtle findings and lack classic symptoms, which makes the diagnosis difficult. The standard office-based test to determine the presence of peripheral vascular disease is calculation of the ankle-brachial index. Magnetic resonance arteriography, duplex scanning, and hemodynamic localization are noninvasive methods for lesion localization and may be helpful when symptoms or findings do not correlate with the ankle-brachial index. Contrast arteriography is used for definitive localization before intervention. Treatment is divided into lifestyle, medical, and surgical therapies. Lifestyle therapies focus on exercise, smoking cessation, and dietary modification. Medical therapy is directed at reducing platelet aggregation. In addition, patients with contributing disorders such as hypertension, diabetes, and hyperlipidemia need to have these conditions managed as aggressively as possible. Surgical therapies include stents, arterectomies, angioplasty, and bypass surgery.

Constriction, Pathologic↗
PubMed1976

Peripheral arterial insufficiency, effect of physical training on walking tolerance, calf blood flow, and blood flow resistance.

Twenty-three patients with intermittent claudication were submitted to physical training during 4-6 months. Eleven other patients with intermittent claudication served as a control group and were given placebo tablets during the same period. The aim of the investigation was to study the influence of physical training on the blood flow conditions in the calf. The effect of treatment on walking tolerance, on calf blood flow, blood flow resistance, and systolic blood pressure graident between the systemic circulation and the vascular bed in the calf was studied. Half a year after the end of the treatment period the patients were reexamined. The walking tolerance increased in both groups but more in the trained group. The increase in walking tolerance even in the control group was caused by the fact that the control group began to train to some extent. In neither group the maximal calf blood flow changed significantly compared with the pretreatment values. The maximal blood flow showed an increasing trend in the training group after a period fo 4 months compared with the control goupr (2p greater than 0.10). The blood flow resistance at maximal dilatation did not change significantly as compared with the initial values in any of the groups, but there was a significant difference (2p greater than 0.05) between the two groups with a decrease in the training group after 4 months. The changes in maximal calf blood flow and the changes in blood flow resistance at maximal dilatation were not related to the changes in walking tolerance. Half a year after the treatment period the walking tolerance had not decreased and there was no difference between the two groups. The maximal calf blood flow, the blood flow resistance, and the systolic pressure gradient were unchanged in comparison with the pretreatment values and there were no statistically significant differences between the two groups. The small changes in blood flow conditions observed after physical training cannot be the only factor explaining the well known improvement in walking tolerance. However, training may cause a redistribution of the blood flow in the working muscle.

Aged↗
PubMed1998

[Diagnostic and therapeutic stragegies in peripheral obliterative arteriopathy: non-drug treatment].

The therapeutic management of patients with peripheral arterial disease relies initially on the assessment of the severity of arterial insufficiency. At this stage, measurement of ankle systolic pressure plays a particularly important role, and is an essential part of the clinical examination. When the severity of ischaemia jeopardises the survival of a limb, the limitations associated with medical treatment clearly justify all steps being taken to enable the patient to benefit from revascularisation. In this often fragile host environment, endovascular techniques play an important part. As first-line procedures, they have a place within a multidisciplinary management approach, particularly since further surgical procedures, such as distal bypass, often prove necessary. For patients at the intermittent claudication stage, treatment indications become more complex. They include the functional repercussions of peripheral arterial occlusive disease and the cardiovascular prognosis for the patient, which is determined by assessing the extent of the arterial disease. Ultrasonography provides a topographical evaluation of the lesions and their haemodynamic repercussions. This investigation is crucial for screening patients who present with a lesion that may be appropriate for endovascular surgery. Ultrasonography is often programmed at the same time as arteriography. For patients with intermittent claudication, surgical revascularisation is considered only after a minimum 3-month period of medical treatment, for those who have significant functional impairment. In some instances, ultrasonographic evaluation, or even arteriography, may reveal lesions associated with a real risk of deterioration, such as arterial or popliteal aneurysm, and this constitutes the basis of the indication. The development of endovascular techniques has broadened the indications for surgical revascularisation to include patients with intermittent claudication. As a result, there has been a radical change with regard to the management of these patients, limiting the number for whom medical treatment is the only feasible solution.

Arterial Occlusive Diseases↗
PubMed1998

[Evaluation of the impact of peripheral obliterative arteriopathy on quality of life].

Peripheral arterial occlusive disease is a common condition with possible serious consequences. It is usually diagnosed at the intermittent claudication stage. There are 2 objectives of treatment: to prevent ischaemic attacks and to improve quality of life. Treatment efficacy is, however, usually evaluated only in terms of walking distance. When making medical decisions, it is now generally accepted that patients are as much concerned by quality of life as by life expectancy, particularly with regard to chronic diseases for which the aim of therapy is not only to treat the disease but also to relieve pain or restore function. Quality-of-life evaluation is therefore necessary to assess treatment efficacy, guiding clinicians in their choice of therapy and manufacturers in their choice of new molecules for development. Three types of instruments can be used to evaluate quality of life. Currently, those most often used are health status and health-related quality-of-life scales. These scales can be nonspecific, giving information on both health status and quality of life independently of any particular condition [the Medical Outcomes Study (MOS) Short Form-36 items (SF-36), for example], or they may be relevant to one disease. Specific scales are usually more sensitive than nonspecific ones. When the ARTEMIS scale, which is specific to peripheral arterial occlusive disease, was developed in 1993, there were 400 scales in existence. However, none were specific to peripheral arterial occlusive disease. The ARTEMIS scale is a self-administered questionnaire, composed of a general (SF-36) and a specific instrument. It comprises 64 items covering the 8 dimensions of the SF-36, 5 specific dimensions and 2 differential dimensions (perception of health status evolution and perception of the future). The ARTEMIS questionnaire was validated in 177 patients with intermittent claudication (phases IIa and IIb of the Leriche and Fontaine classification). Results obtained with the ARTEMIS questionnaire are presented and compared with those obtained by other authors using nonspecific or specific scales for quality-of-life evaluation. All results showed that intermittent claudication has a significant effect on the various dimensions of quality of life (except in one study). Nevertheless, the relationship between walking distance (or other functional measures) and quality of life did not prove to be as close as had been expected, indicating that functional measures do not reflect the patient's overall perception of the disease. The ARTEMIS questionnaire showed that quality-of-life scores were significantly higher (better quality of life) in patients with walking distances greater than 500 metres than in those with shorter walking distances (less than 500 metres). Moreover, quality-of-life scores were both high and similar in patients with walking distances greater than 500 metres, while in patients with shorter walking distances quality-of-life scores ranged from high (good quality of life) to low (bad quality of life). In the absence of curative treatment, the patient's perception of quality of life must therefore be evaluated prior to any treatment. Treatment will help to prevent ischaemic attacks in patients with walking distances greater than 500 metres, and will have a preventive effect and improve functional measures in patients with low quality-of-life scores, regardless of walking distance. The ARTEMIS questionnaire can therefore assist clinicians in their choice of therapeutic strategy and in the evaluation of treatment efficacy.

Arterial Occlusive Diseases↗
PubMed2005

Quality of life and exercise performance after aortoiliac stent placement for claudication.

PURPOSE: To determine the effect of aortoiliac stent placement on walking ability and health-related quality of life (QOL) for elderly individuals with moderate to severe intermittent claudication. MATERIALS AND METHODS: A prospective single-center study was performed in 35 consecutive patients (46 symptomatic limbs) with intermittent claudication and aortoiliac insufficiency (mean age+/-SD, 61.1 years+/-9.5). Baseline and follow-up data to 12 months included clinical status, ankle-brachial index (ABI), exercise performance according to a standardized treadmill exercise protocol, and self-reported health-related QOL according to the Walking Impairment Questionnaire (WIQ) and the Short Form 36 (SF-36). RESULTS: Comparing baseline with 12-month data, mean ABI significantly improved from 0.64+/-0.15 to 0.89+/-0.19 (P<.01). Similarly, mean initial claudication duration improved from 1.7 minutes+/-1.0 to 4.7 minutes+/-3.3 and maximum walking duration on the treadmill test improved from a mean of 3.3 minutes+/-1.8 to 8.7 minutes+/-4.4. All WIQ subscales showed significant improvement, and the SF-36 physical component scale as well as subscales of physical functioning, bodily pain, role physical, and vitality showed significant improvement. There was no 30-day mortality. Complications in the perioperative period that required treatment were observed in three patients (9%), but surgery was not required for any complications. Importantly, urgent or emergent surgery was not required for any complication and no permanent disability related to complications occurred. CONCLUSIONS: A high technical success rate (97%) and low complication rate were observed. Exercise performance and health-related QOL results improved significantly after stent placement. Revascularization with stent placement should be strongly considered in addition to conservative management for moderate to severe claudication with aortoiliac obstruction. A randomized clinical trial would be needed to gauge the relative effectiveness of stent implantation and conservative therapy.

Adult↗
PubMed1977

[Cystic degeneration of the vessel walls. The differential diagnosis of obliterative angiopathies: (author's transl)].

Cystic degeneration of the vessel wall is a rare disease predominantly localized in the region of the popliteal artery. It appears in the frequent clinical picture of intermittent claudication. Two cases are presented. The etiology of this syndrome is not clear. The appearance of intermittent claudication, preferably in middle-aged men without risk factors is typical for an obliterative angiopathy. Angiophically there are smooth-walled stenoses or occlusions, especially of the popliteal artery, with an otherwise inconspicuous vascular system. The prognosis after surgical treatment by excision or resection is good.

Adult↗
PubMed1997

Quality of life changes after angioplasty for claudication: medium-term results affected by comorbid conditions.

Rapid improvements in walking distance and quality of life have been identified in patients with intermittent claudication following percutaneous transluminal angioplasty, but the medium-term results are less well defined. The aim of this study was to assess quality of life and walking distance in the medium term. Walking distance was assessed before percutaneous transluminal angioplasty and at 6 weeks and 1 year after the procedure using a previously validated questionnaire. At the same time, quality of life was assessed using a EuroQol questionnaire and a visual analogue scoring system. Twenty-four patients (12 men, 12 women, mean age 65 years) underwent successful percutaneous transluminal angioplasty (five iliac, 17 femoropopliteal, two both). Significant improvements in walking distance and quality of life were demonstrated following percutaneous transluminal angioplasty. These were maintained at 1 year, although perceived health state deteriorated. During the study period, six patients developed other serious comorbidities. Development of comorbid conditions may affect the medium-term outcome of quality of life studies in patients treated for intermittent claudication. Data from such studies should therefore be interpreted with care.

Aged↗
PubMed2003

Pharmacotherapy and behavioral intervention for peripheral arterial disease.

Lower-extremity peripheral arterial disease is a chronic disease process resulting from atherosclerotic obstruction of major vessels supplying the legs. A significant manifestation of systemic atherosclerosis, it is estimated to affect more than 10 million adults in the United States alone. The reported incidence is a conservative estimate, because many patients who suffer from symptoms of peripheral arterial disease attribute them to "normal aging" and may not report them to their physician. Additionally, physicians may miss the diagnosis if a comprehensive history and vascular examination are not a routine part of their assessment. The hallmark symptom of peripheral arterial disease is intermittent claudication, defined as reproducible muscular leg pain that is precipitated by exercise and relieved by rest. Intermittent claudication not only limits functional capacity and adversely affects quality of life but is also an ominous predictor of increased risk for myocardial infarction, stroke, and cardiovascular death. Due to the chronicity of atherosclerosis, medical intervention is most successful when a comprehensive team approach is utilized, involving the patient, family, and vascular health professionals. Treatment for peripheral arterial disease is aimed at first, minimizing symptoms and disease progression via smoking cessation, supervised exercise therapy, pharmacotherapy, and/or revascularization, and second, minimizing the risk of cardiovascular mortality via risk factor identification and reduction, and the use of antiplatelet therapy.

Arterial Occlusive Diseases↗
PubMed1999

Reliability of treadmill testing in peripheral arterial disease: a comparison of a constant load with a graded load treadmill protocol.

This study aims to evaluate the reliability of repeated graded workload treadmill testing (G-test; 2 mph; 0% grade, increasing 2% every 2 min) and to compare the reliability of a constant workload treadmill protocol (C-test; 2 mph; 12% grade) versus the graded workload treadmill protocol in patients with intermittent claudication, studied longitudinally. A clinical trial investigating an orally stable prostacycline derivative that included 330 patients with intermittent claudication was performed. The trial employed three active treatment groups and one placebo group. Because there were no significant inter-group differences at baseline or after treatment, data from all groups were pooled for the evaluation of treadmill test reliability. Treadmill data were obtained from a 2-week run-in phase where three G-tests were performed, as well as from the beginning and the end of a 3-month double-blind phase where a G-test and a C-test were performed in random order. Treadmill test reliability was described through test process-related and between-subject variances and also using variance-derived parameters such as the reliability coefficient (RC) and the relative precision (RP). A higher value for the RC and a lower value for the RP indicate that the test variability is predominantly due to between-subject variance and not to test process-related variance. Estimates of variance were described for both the maximal or absolute claudication distance (ACD) and the initial claudication distance (ICD) with each treadmill test. Reliability estimates are reported for the total study sample and for patients with baseline claudication distances < or =300 feet and >300 feet (approximately < or =100 m; >100 m), as measured with the C-test. The cut-off value was empirically chosen to separate severely diseased from mild to moderately diseased claudicants. Theoretical considerations suggest that reliability measures may differ in these subgroups. With repeated testing during the run-in phase for the measure of ACD, the G-test had an RC of 0.952 and an RP of 21.9%. With the comparison of both test protocols in the entire study population for the measurement of ACD, the G-test had an RC of 0.902 and an RP of 31.3%, while the C-test had an RC of 0.876 and an RP of 35.2%. The results for ICD on the G-test were an RC of 0.809 and an RP of 43.7%, while the C-test had an RC of 0.737 and an RP of 51.3%. The reliability of the ACD measurement for RC and RP was numerically superior to those for the ICD for both protocols. In patients with a baseline ACD < or =300 feet, the RC for ACD on the G-test was 0.827 and the RP was 41.4%. In contrast, on the C-test the RC decreased to 0.250 and the RP increased to 86.6%. These changes in RC and RP were due to a marked decrease in the between-subject variance, demonstrating the inability of the C-test to separate appropriately the different claudication distances in populations with highly limited baseline claudication distances. During a run-in phase, the G-test has excellent test characteristics. During the longitudinal phase of a trial, the reliability of G-tests and C-tests are comparable in the entire study population. However, in patients with low claudication distances, the G-test should be given preference over the C-test.

Adult↗
PubMed2000

The acute effects of intermittent pneumatic foot versus calf versus simultaneous foot and calf compression on popliteal artery hemodynamics: a comparative study.

INTRODUCTION: Intermittent pneumatic compression (IPC) is currently being investigated with respect to its effect on distal arterial volume flow in patients with peripheral vascular disease. Recently published data have shown a substantial acute enhancement in arterial calf inflow in response to IPC of the lower limb in both intermittent claudication and leg ischemia. PURPOSE: The aim of the study was to compare the immediate effects of intermittent pneumatic foot (IPC(foot)) versus calf (IPC(calf)) versus simultaneous foot and calf compression (IPC(foot+calf)) on popliteal artery hemodynamics in patients with intermittent claudication (Fontaine II) and in normal subjects, using duplex ultrasonography. For this purpose, 25 limbs of 20 healthy subjects (age range [mean], 51-74 [64] years) and 31 limbs of 25 claudicants (age range [mean], 56-81 [66.5] years; resting ankle-brachial indices, 0.38-0.75 [0.55]) were examined in the sitting position with and without IPC compression. RESULTS: Mean popliteal artery flow in healthy subjects increased by 98.8% on application of IPC(foot), 188% with IPC(calf), and 274% with IPC(foot+calf) (all P <.001). Mean flow in claudicants increased by 58% on application of IPC(foot), 132% with IPC(calf), and 174% with IPC(foot+calf) (all P <.001). The mean velocity, peak systolic velocity, and end diastolic velocity displayed a pattern of change similar to that for volume flow in both groups. Pulsatility index decreased in both groups on application of IPC; the lowest values were generated with IPC(foot+calf). CONCLUSION: Of the three compression modes investigated, IPC(foot+calf) was the most effective means of acutely augmenting arterial calf inflow in arteriopaths and normals. The significant increase in end diastolic velocity and decrease in pulsatility index indicate that peripheral vasodilatation is the central mechanism in this impulse-related flow augmentation. Prospective trials are indicated to determine the clinical potential of the long-term effects of IPC(foot+calf) in patients with symptomatic peripheral vascular disease.

Aged↗
PubMed1998

Smoking, hemorheologic factors, and progression of peripheral arterial disease in patients with claudication.

PURPOSE: The purpose of the current study was to determine whether hemostatic and rheologic factors are associated with the deterioration of peripheral arterial disease in patients with intermittent claudication and the influence of smoking and severity of underlying disease on these relationships. METHODS: We conducted a prospective cohort study with a 6-year follow-up period of a consecutive series of 607 patients with uncomplicated intermittent claudication. The study setting was the Peripheral Vascular Clinic, Royal Infirmary of Edinburgh. The main outcome measures were peripheral vascular intervention or onset of severe chronic leg ischemia (rest pain, ulceration, gangrene). RESULTS: A total of 210 patients died during follow-up. Two hundred three patients did not have a vascular event or deterioration of limb ischemia, 45 patients underwent a peripheral vascular intervention, and 64 progressed to severe chronic leg ischemia. Median levels (interquartile ranges) of whole blood viscosity were significantly higher in the vascular intervention group (3.75 mPa/sec; range, 3.38 to 4.13 mPa/sec) than in those who did not deteriorate 3.48 mPa/sec; range, 3.06 to 3.83 mPa/sec) (p < or = 0.05), and plasma von Willebrand factor was higher in those with severe chronic leg ischemia (154.0 IU/dl; range, 122.0 to 187.0 IU/dl) than in those who did not deteriorate (131.0 IU/dl; range, 106.0 to 165.0 IU/dl) (p < or = 0.01). After adjustment for age, sex, cigarette smoking, and ankle brachial pressure index, the levels of plasma fibrinogen and blood and plasma viscosities were each associated with an increased risk of vascular intervention (all p < or = 0.05). There were no significant associations between any of the hemorheologic factors and the risk of severe chronic leg ischemia on multivariate analyses. CONCLUSION: Elevations in rheologic factors may have important effects on further reduction of blood flow in the legs of patients with claudication and promote worsening ischemia and clinical progression of symptoms.

Blood Viscosity↗
PubMed1989

The effect of six months intensive physical training on the circulation in the legs of patients with intermittend claudication.

Out of 94 patients with intermittent claudication 65 completed a program of 6 months intensive physical training. Every 2 months the blood pressure indices at the thigh and at the ankle and the blood flow in the calf were measured at rest, after 5 min arterial occlusion and after exercise of the calf muscles until claudication. First the reproducibility of the blood pressure indices and the blood flow values was established. An increase of 15 in the pressure indices was considered to be substantial. An increase of 6.0 ml/100 ml/min in flow values was considered a substantial change. The blood pressure indices did not increase significantly during the training period, the blood flow values increased significantly. On the basis of the non-invasive tests no reliable statement can be made as to the expected result of the training.

Aged↗
PubMed1996

The influence of smoking cessation and hypertriglyceridaemia on the progression of peripheral arterial disease and the onset of critical ischaemia.

OBJECTIVE: To investigate whether smoking and other cardiovascular risk factors were associated with deterioration of ankle/brachial pressure index or onset of critical ischaemia in patients with mild to moderate intermittent claudication. DESIGN AND SETTING: Longitudinal study in a London teaching hospital. SUBJECTS: 415 consecutive smokers, with symptoms of intermittent claudication and an ankle/brachial pressure index of <0.9, referred for a surgical opinion between April 1985 and December 1990, who were not considered for an immediate surgical procedure. MAIN OUTCOME RESULTS: Reduction in ankle/brachial pressure index of >0.14, onset of critical limb ischaemia. RESULTS: After one year of follow up 183 patients (44%) had stopped smoking (as evaluated by biochemical markers). With longer follow up only 110 patients (27%) had maintained smoking cessation. There were no differences in age, sex, and previous tobacco exposure between stoppers and smokers, but the proportion of diabetics among stoppers (20%) was greater than among those who continued smoking (10%) [p=0.01]. The annual rate of deterioration of ABPI was 21, 16 and 17% respectively in the first, second and third year of follow-up and the onset of critical ischaemia was observed in 52 patients (12.5%) during the period of follow-up. In univariate analyses, continued smoking, diabetes and presence of ischaemic heart disease were not associated with an increased risk of deterioration of ABPI, but hypertriglyceridaemia (> or = 2.2 mmol/l) was, [relative risk 1.7(95% CI 1.21-2.37), p=0.003], and patients having systolic blood pressure in the middle tertile (153-170 mmHg had a reduced risk of deterioration of ABPI, p=0.026. Hypertriglyceridaemia (> or = 2.2mmol/l) was the only independent factor associated with deterioration of ABPI in multivariate analysis [relative risk 1.8(95% CI:1.23-2.59), p=0.003] and also was associated with a relative risk of onset of critical ischaemia of 1.9 [(95% CI: 1.08-2.87), p=0.035], compared with triglyceride levels of <2.2mmol/l. CONCLUSION: For those with mild to moderate claudication, the lack of immediate benefit from cessation of smoking appears to be associated with a gradual return to smoking. Hypertriglyceridaemia was identified as the most important independent factor associated with the progression of peripheral arterial disease and onset of critical ischaemia.

Aged↗
PubMed2005

Pseudoclaudication as a manifestation of diabetic neuropathy.

We present the case of a 64-year-old male Type 1 diabetic patient with painful diabetic neuropathy masquerading as intermittent claudication. Examination of the peripheral circulation (both arterial and venous) was normal. An MRI scan excluded lumbar spinal stenosis and nerve root compression as the cause of claudication. The case suggests that, in the absence of other identifiable causes and in the presence of peripheral diabetic neuropathy, "intermittent claudication" may be due to the neuropathy itself.

Ankle↗
PubMed2005

Occult vascular lesions in patients with atherothrombotic events: the AIRVAG cohort.

OBJECTIVES: To determine clinical parameters that could predict occult vascular lesions (OVL) in patients with symptomatic atherosclerosis. PATIENTS AND METHODS: Prospective evaluation of 269 consecutive patients with symptomatic atherosclerosis (cerebral 32%, peripheral vascular 15%, and coronary 53%): complete laboratory, ultrasound exams (carotids, aorta, heart), ankle-brachial index. OVL were defined as: abdominal aortic aneurysm, carotid artery stenosis > 50%, or left ventricular segmental contraction abnormalities when affecting a different vascular bed from the symptomatic. Clinical predictors of OVL were evaluated by logistic regression analysis. RESULTS: OVL were found in 35 patients (13%): 12 abdominal aortic aneurysms, 21 carotid artery stenosis and 15 segmental left ventricular contraction abnormalities. OVL were associated with peripheral vascular disease (intermittent claudication or reduced ankle-brachial index), cigarette smoking, increased pulse pressure, microalbuminuria and hyperhomocysteinemia. By multivariate analysis, intermittent claudication (odds ratio 5.8; 95% CI 2.6-12.8) and microalbuminuria (OR 4.2; 95% CI 1.7-10.5) were strong independent predictors of OVL. Similar results were obtained when peripheral vascular disease was defined as reduced ankle-brachial index (OR 5.3; 95% CI 2.4-11.7). CONCLUSIONS: Clinical and subclinical peripheral vascular disease, as well as microalbuminuria are strong independent predictors of OVL in atherosclerotic patients. A screening study of OVL may be warranted in these patients.

Albuminuria↗