[Pathomechanisms of intermittent claudication as a sign of tissue decompensation in arterial occlusive disease].
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An experimental clinical trial was carried out using heparan sulphate in order to assess its antithrombophilic, profibrinolytic and possibly hemorheological characteristics. Twenty patients with stage 2 obliterating arteriopathy of the lower limbs were enrolled in the study. Patients were fully informed regarding the experimental protocol: a controlled, crossover and double-blind study. The population sample included 20 subjects, male and female, mean age 60.9 years who received heparan sulphate at a dose of 200 mg/die (one 100 mg tablet twice a day): treatment continued for 120 days (60 days of treatment with heparan sulphate and 60 days with placebo). The results obtained were in favour of medical therapy which was significantly more effective than placebo in relation to a number of parameters: compared to basal values, walking parameters were improved, recovery times were more rapid and gait was longer. Significant changes in hemocoagulative and hemorheological parameters were also observed (euglobulin lysis time, fibrin degradation products, erythrocytic filtration, hematic viscosity) and their positive trend may account for peripheral hematic perfusion, as shown by photoplethysmographic tests, velocimetric tests and the modification of the Windsor index. Therapeutic efficacy and the good tolerance (one case of gastralgia, two of pyrosis) as well as broad safety margins offered by the drug justify the use of heparan sulphate in all clinical conditions characterized by thrombophilia and local ischemia, above all those which require long-term treatment.
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Reducing the risk factors of people with cardiovascular disease can be beneficial to their health. This article reports on a study into the effectiveness of a health education programme in helping people to reduce their risk factors.
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In the percent study the authors have demonstrated that the peripheral blood flow and resistance as measured by strain-gauge venous occlusion plethysmography were favourably altered by enalapril. The peripheral blood flow increased significantly and since there was no detectable change in ankle pressure this indicated a decrease in resistance during administration of the drug.
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Patients suffering from arteriosclerotic obliterating disease of the lower limbs that present with symptoms of rest pain, ulcers or more or less severe gangrene are considered as candidates for revascularization operation. Apart from the possible non relevance of individual symptoms, in some instances the revascularization operation is indicated solely on the basis of the angiographic evidence. Ascending thrombosis of the abdominal aorta, double or triple blocks, stenosis of the collateral circulation and, broadly speaking, any other situation that suggests a possible superimposition of an episode of acute ischaemia due to thrombosis in a condition of chronic obliterating arteriopathy are considered as absolute indication for revascularization operation. Patients whose conditions are not listed above are considered as stage II and indication for operation in this case is not absolute but relative or "luxury" since its purpose is only to improve the quality of life. The importance of the symptoms must be considered along with other factors, including the personal, social, working, sporting and psychological needs of the specific individual apart from the absence of general risks related to the patient's condition. The vascular surgeon's expertise is obviously fundamental in exactly evaluating the arteriography and in understanding the precise anatomic picture that varies in every single case: in fact, since the operation is optional and not a necessity, correction of the arterial lesions in only advisable when it is possible to carry out and operation that is broadly risk free and with good short and long term results, with reference to the patient's life expectancy.