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Lack of relationship between gait parameters and physical function in peripheral arterial disease.

OBJECTIVE: Physical function is limited in patients with peripheral arterial disease who are symptomatic with intermittent claudication (PAD-IC). When patients with PAD-IC experience claudication, previous reports have described gait abnormalities, including alterations in step length and cadence. This study tested the hypothesis that patients with PAD-IC would have a decrease in usual and maximal walking speed and that this alteration in gait parameters would contribute to their decreased physical function scores, even in the absence of claudication. The aims were to evaluate usual and maximal walking speed and gait parameters (step length, cadence and toe out angle) in subjects with PAD-IC and control subjects with similar baseline activity levels. METHOD: A cross-sectional study of 25 subjects with PAD-IC compared with 26 age-matched controls was conducted in a research laboratory in an academic medical center. Study subjects were similar in age, gender, and physical activity status. Subjects with PAD-IC had an ankle-brachial index <0.90 in at least one leg and reported symptoms of intermittent claudication that limited walking ability. Subjects in either group were excluded if they used assistive devices to walk or were limited in walking ability by orthopedic, neurologic, cardiac, or pulmonary symptoms. Gait parameters were assessed at the onset of walking (before the development of claudication pain in the PAD-IC group) at self-selected and maximal walking speeds during which step and stride characteristics were collected. Subjects completed a physical activity recall, a Short Form questionnaire (SF-36), and a 6-minute walk that was limited by claudication in the PAD-IC group. RESULTS: During gait testing, no patient with PAD-IC developed claudication. There were no significant differences between the PAD-IC and control groups in usual or maximal walking speed or other gait variables (step length, cadence, stride width, toe out angle). In contrast, the SF-36 physical function score was reduced 15.2 percentage points (P < .02) and the summary physical component score was reduced 6.7 percentage points in the PAD-IC group compared with controls (P = .002). In addition, the 6-minute walk distance was significantly less in the PAD-IC group than in the control group by 308.8 feet (P < .001). A series of bivariate analyses demonstrated that PAD-IC was the best predictor of reduced physical function, whereas no gait parameter was associated with reduced physical function. CONCLUSION: Patients with PAD-IC have significantly reduced 6-minute walk distance and reduced physical function by questionnaire scores that was not explained by any effects of PAD-IC on walking speed and selected gait parameters assessed before the onset of claudication pain.

Aged↗

Beneficial clinical effects of ozonated autohemotherapy in chronically dialysed patients with atherosclerotic ischemia of the lower limbs--pilot study.

Ozonated autohemotherapy is a controversial but successful method of treatment, used in particular in European countries. There are many fields in which medical ozone could be of value: treating different infections, immunodeficiency syndromes, neoplasms. Encouraging results have also been achieved in the treatment of atherosclerotic ischemia of the lower limbs. In this preliminary study, the influence of blood ozonation on the intensity of symptoms of ischemia of the lower extremities was analysed among dialysed patients with chronic renal failure. We examined 5 hemodialyzed patients and 7 patients treated with peritoneal dialysis immediately before and after 14 sessions of ozonated autohaemotherapy. Eleven patients (91.6%) reported a subjective decrease in perceived intensity of ischemic pains, or observed prolongation of intermittent claudication distance. During march tests performed on a treadmill, we found significant prolongation of intermittent claudication distance in all examined patients - 65.6% (mean value, p (< or =0.01). Patients treated with peritoneal dialysis achieved much greater improvement than did hemodialyzed patients (165% vs. 42%). We concluded that autohemotherapy with ozone, in a concentration of 34.4 mcg/ml of blood, is safe, easily applied and may be useful In the therapy of atherosclerotic ischemia of lower extremities among dialyzed patients. It could also be a complement to current treatment, especially in cases where the latter has failed.

Adult↗

[Chronic occlusive arteriopathy of the lower limbs: therapeutic approach].

Chronic arterial insufficiency of the lower limbs is characterized by intermittent claudication often localized to the calf. These early clinical symptoms are the results of the atherosclerotic process of the vasculature of the lower extremities. The treatment is aimed at reducing or eliminating the ischemic pain and at preventing progression of the atherosclerotic disease. Whether surgical or nonsurgical measures are used, the cornerstone of patient care lies in correction of the risk factors. Smoking cessation and exercise therapy remain the fundamental measures in medical treatment of intermittent claudication. percutaneous transluminal angioplasty is an appropriate therapeutic option under certain criteria, especially for the iliac arteries. In the absence of randomized studies, surgery remains the treatment of choice for peripheral revascularization in presence of limb-threatening ischemia or ischemic ulcers. New procedures and materials are presently under trial to test the safety and efficacy of alternative methods or revascularization that would provide better long-term patency rates and shorter hospitalization periods.

Amputation, Surgical↗

Effects of exercise rehabilitation on endothelial reactivity in older patients with peripheral arterial disease.

Peripheral arterial disease (PAD) is a major cause of morbidity and mortality. Endothelial function, which is a measure of vascular health, is impaired in patients with PAD. We examined the effects of 6 months of aerobic exercise rehabilitation on brachial artery endothelial function, assessed using high-frequency ultrasonography, and calf blood flow in 19 older PAD patients (age 69 +/- 1 years, mean +/- SEM) with intermittent claudication (ankle to brachial artery index of 0.73 +/- 0.04). After exercise, the time to onset of claudication pain increased by 94%, from 271 +/- 49 to 525 +/- 80 seconds (p <0.01), and the time to maximal claudication pain increased by 43%, from 623 +/- 77 to 889 +/- 75 seconds (p <0.05). Exercise rehabilitation increased the flow-mediated brachial arterial diameter by 61%, from 0.18 +/- 0.03 to 0.29 +/- 0.04 mm (p <0.005), as well as the relative change in brachial arterial diameter from the resting state by 60%, from 4.81 +/- 0.82% to 7.97 +/- 1.03% (p <0.005). Maximal calf blood flow (14.2 +/- 1.0 vs 19.2 +/- 2.0 ml/100 ml/min; p = 0.04), and postocclusive reactive hyperemic blood flow (9.8 +/- 0.8 vs 11.3 +/- 0.7 ml/100 ml/min; p = 0.1) increased 35% and 15%, respectively. In conclusion, exercise rehabilitation improved ambulatory function, endothelial-dependent dilation, and calf blood flow in older PAD patients with intermittent claudication.

Aged↗

Aortic and lower limb artery calcification in type 2 (non-insulin-dependent) diabetic patients and non-diabetic control subjects. A five year follow-up study.

The purpose of the present study was to assess among a representative group of middle-aged newly diagnosed type 2 diabetics and control subjects the baseline prevalence and 5-year incidence of arterial calcifications of aorta and lower limb and their relationship to cardiovascular morbidity. The relationship of baseline risk factors to the development of arterial calcifications was also studied. At the time of diagnosis the age-adjusted prevalence of aortic and lower limb intimal calcifications was higher in diabetics than in control subjects (aortic calcifications: 29 vs. 17% for men, P = 0.05; 26 vs. 19% for women, P = 0.06; lower limb intimal calcifications: 24 vs. 12% for men, P = 0.02; 10 vs. 7% for women; P = NS), whereas no significant difference in baseline prevalence of lower limb medial calcifications was observed (15 vs. 21% for men, 9 vs. 10% for women). The 5-yr incidence of aortic calcifications in both sexes and of lower limb calcifications in men was similar in diabetic and control subjects, but the incidence of lower limb calcifications was higher in diabetic women than in control women (intimal: 33 vs. 11%, P = 0.009: medial: 29 vs. 14%, P = 0.05). The baseline prevalence of abdominal aortic (37 vs. 22%, P = NS for diabetics; 42 vs. 16%, P = 0.02 for control subjects), lower limb intimal (24 vs. 16% for diabetics, P = NS; 15 vs. 7% for control subjects, P = NS) and medial calcifications (23 vs. 7% for diabetics, P = 0.03) were higher in subjects who developed intermittent claudication during the follow-up than in those free of it at the 5-yr examination. Abnormalities in VLDL-metabolism and high systolic blood pressure were associated with the development of aortic calcification in diabetic subjects. In conclusion, already at the time of diagnosis atherosclerotic calcifications are more prevalent in type 2 diabetics than in nondiabetic subjects. During the follow-up diabetic women, but not men, had higher incidence of lower limb intimal and medial calcifications than non-diabetic subjects. Arterial calcifications tended to be associated with the development of intermittent claudication during the follow-up in diabetic and control subjects.

Aorta, Abdominal↗

Isokinetic plantar flexor performance and fatiguability in peripheral arterial insufficiency. Effects of training vs. vascular surgery.

Seventeen men with peripheral arterial insufficiency and intermittent claudication (maximum walking tolerance less than 1000 m) underwent a bypass operation (group A, n = 8) or carried out simple exercises (repeated heel-raising) at home (group B, n = 9). The effects of treatment on the isokinetic performance of the plantar flexors and on fatiguability were assessed. Before treatment both groups had similarly low Doppler pressure indices, maximum performance and fatiguability level. Maximum walking tolerance was increased by treatment in both groups. Maximum plantar flexor output rose in group A, partly due to increased range of motion, but was only slightly changed in group B. Bypass surgery also led to increased electrical efficacy (contractional work/integrated electromyogram). Plantar flexor fatiguability normalized in six of the eight group A men, but in only a few from group B. Improvement in group B may be explained by specific adaptation of (mainly type 2B) muscle fibres. After bypass the increased capacity to remove combustion products may be the major reason for normalized fatiguability. Bypass surgery is preferable for most cases of intermittent claudication.

Arterial Occlusive Diseases↗

Large artery involvement in giant cell (temporal) arteritis.

Of 248 patients with giant cell arteritis, 34 had evidence that the disease affected the aorta or its major branches. Symptoms suggestive of large artery involvement were intermittent claudication of an extremity, paresthesias, and Raynaud's phenomenon. Physical findings included absent or decreased large artery pulses and bruits over large arteries. Four patients presented with decreased upper extremity pulses as the initial manifestation of their arteritis. Nine other patients under treatment for temporal arteritis or polymyalgia rheumatica first developed evidence of large artery involvement as corticosteroid therapy was tapered or discontinued. Angiography, performed in 10 patients, was helpful in indicating arteritis rather than atherosclerosis as the cause of large artery disease. Three patients died with aortic rupture, and, at autopsy, widespread giant cell arteritis was found. However, when corticosteroids were given in adequate doses, the response was favorable in most patients; intermittent claudication decreased and the pulses improved.

Adrenal Cortex Hormones↗

[Long-term results of the treatment of arteritis with intra-arterial injections using Reboul's technique].

We have made a non-selective search for patients undergoing treatment for more than five years for an arterial deficiency of the lower limbs. Most of the patients studied suffered from intermittent claudications for which surgical treatment was impossible (distal lesions, diabetes, coronaritis) or had failed (sympathectomy, recurrences). Faced with the inefficiency of vasodilators, and in addition to strict medical treatment of the risks factors of arterio-sclerosis disease (tobacco, obesity, hypercholesterol, sedentary habits), we treated these patients using intra-arterial injections according to the method of Reboul. Our patients generally received one injection per week of xylocaine-priscol-pronestyl. Once an improvement appeared, these injections were spaced out so as to become semi-annual. We grouped 67 patients suffering from intermittent claudications and 5 patients suffering from arteritis ulcers. We studied the results obtained from this so-called palliative treatment (the claudication going from an average 201 meters to 3,395 meters after five years and cure of the ulcers).

Aged↗

Acute effects of haemodialysis on cutaneous microcirculation in patients with peripheral arterial occlusive disease.

BACKGROUND: Peripheral arterial occlusive disease (PAOD) is an increasing problem in patients on maintenance haemodialysis. Alterations in microvascular perfusion accompany and complicate arteriosclerosis of large vessels and might contribute to the disease process. The aim of the study was to investigate the acute effects of haemodialysis on the cutaneous microcirculation in 26 patients with and without intermittent claudication. METHODS: Cutaneous perfusion was assessed by measuring transcutaneous oxygen pressure (tcPO2) and skin temperature at the dorsum of the foot. After standardized cooling to 15 degrees C of a 2cm2 skin area, the time to reach baseline skin temperature was evaluated as an indirect parameter of reactive hyperaemia. RESULTS: During haemodialysis, tcPO2 dropped significantly in both groups. The decrease in tcPO2 was more pronounced in patients with PAOD (20% vs 15% n.s.). The reactive hyperaemia response was reduced significantly in patients with intermittent claudication indicated by a prolonged time to reach baseline skin temperature after cooling. Values of tcPO2 and reactive hyperaemia did not reach baseline values at the end of haemodialysis in either group. CONCLUSIONS: Nutritive skin perfusion is impaired during haemodialysis. These changes are more pronounced in patients with PAOD and persist after dialysis. These findings are relevant for the treatment of patients with vascular disease on maintenance haemodialysis.

Adult↗

Epidural hematoma of the lumbar spine, simulating extruded lumbar disk herniation: clinical, discographic, and enhanced magnetic resonance imaging features. A case report.

STUDY DESIGN: This case report describes a patient with epidural hematoma of the lumbar spine and progressive intermittent claudication whose imaging findings were similar to those of a patient with extruded disk herniation. OBJECTIVES: To highlight the diagnosis and cause of the lumbar epidural hematoma. SUMMARY OF BACKGROUND DATA: The characteristics of imaging of lumbar epidural hematomas have been reported. To the authors' knowledge, a case of epidural hematoma with leakage of the contrast medium into the mass at discogram has never been reported. METHODS: A case of a lumbar epidural hematoma with 10-15 minutes of intermittent claudication was described. There was no history of major trauma or coagulation disorders. Diagnosis was made using magnetic resonance imaging, myelography, discography, and computed tomography. The magnetic resonance image demonstrated a relatively large, rounded mass posterior to the S1 vertebral body with L5-S1 disc protrusion. A gadolinium-enhanced magnetic resonance image showed a rim-enhancing lesion. A discogram revealed leakage of the contrast medium into the mass. The mass was diagnosed as extruded disk herniation, and surgery was performed. RESULTS: At surgery no evidence of obvious disk herniation was detected, but the encapsulated hematoma was found. CONCLUSIONS: A case of chronic lumbar epidural hematoma in which clinical and imaging findings were similar to those of an extruded lumbar disk herniation was reported. Clinical information and results of imaging studies should be analyzed carefully because the imaging findings of contained epidural hematomas are often quite specific to this condition and can be differentiated from those of extruded disc herniations. Management of chronic lumbar epidural hematoma may be altered by a specific diagnosis.

Adult↗

[Congenital malformations of the abdominal aorta].

Thirty-four patients with a congenital malformation of the abdominal aorta were observed from 1970 to 2002. Thirty-two patients had associated lesions of the renal artery (ies) and 13 had lesions of the splanchnic arteries. Arterial hypertension was present in 32 patients, and two patients had intermittent claudication in the lower limbs. Two sudden deaths occurred before surgery was undertaken. The 32 other patients were operated on. Aortic bypass was performed in 10 patients. The lesions of the renal artery (47 kidneys at risk) were treated by nephrectomy in two cases and vascular repair in 45 cases. Six reconstructions of the superior mesenteric artery were carried out during the same procedure. There were no postoperative deaths. After surgery, arterial hypertension was cured in 74% of the patients, improved in 23% and unchanged in 3%. The intermittent claudication disappeared after aortic bypass in the two patients concerned. In four patients, deterioration of the renal artery repair led to repeat surgery. All aortic reconstructions remained patent, and no late anatomic deterioration occurred. Surgical treatment of renal artery lesions is necessary in most patients. Aortic repair should be reserved for tight stenoses and should be done as close as possible to the end of the growth phase.

Adolescent↗

Chronic muscle stimulation improves ischaemic muscle performance in patients with peripheral vascular disease.

There is currently no established treatment for intermittent claudication with proven long term benefit. Exercise classes have been shown to improve walking distance. Chronic electromyostimulation (CEMS) a method of stimulating skeletal muscle has effects on normal muscle which may also benefit claudicants. We investigated the effects of one month of CEMS on claudicants in a single blind placebo controlled study. Patients were randomised to either CEMS (treatment) or transcutaneous nerve stimulation (TENS) placebo. The effects of the two modalities were assessed using the conventional measures of claudicating distance (CD), maximum walking distance (MWD), ankle-brachial pressure index (ABPI) and pressure recovery time (PRT). Muscle performance was assessed by the fatigue index (FI) a technique determining the decrease in ischaemic muscle response to repeated contraction. After 4 weeks treatment the CEMS group showed significant improvements in their median CD (88 to 111) and MWD (118 to 158); this was not seen in the control group. Muscle performance also increased significantly during the 4 weeks of treatment in the CEMS group but not in the control group. These changes were not maintained after CEMS was stopped. This pilot study suggests that CEMS may well have a role to play in the treatment of intermittent claudication though a number of further studies need to be undertaken.

Aged↗

Effects of lumbar acupuncture stimulation on blood flow to the sciatic nerve trunk--an exploratory study.

INTRODUCTION: Acupuncture may have a role in the treatment of intermittent claudication of the cauda equina due to lumbar spinal canal stenosis. The aim of this study was to explore the possible physiological mechanisms. METHODS: In a laboratory experiment, manual acupuncture was performed at a point adjacent to the sixth lumbar vertebra of 13 animals and its effect on sciatic nerve blood flow was measured using a laser Doppler flowmetry. Simultaneously, changes in blood pressure and cardiac rate were observed. Each animal was stimulated four to eight times, making a total of 58 experiments. RESULTS: Acupuncture stimulation did not produce consistent changes in sciatic nerve blood flow, with increased and decreased blood flow as well as no change in blood flow observed. Among the 58 individual experiments, sciatic nerve blood flow was increased in 33, reduced in 12, and unchanged in 13. Approximately half of the stimulations showed a correlation between blood flow and blood pressure change. CONCLUSION: Our results indicate that lumbar acupuncture stimulation can have an influence on sciatic nerve blood flow. The effect is dependent not only on blood pressure but also other factors, for example vasodilator and vasoconstrictor nerve activity. This mechanism may contribute to a clinical effect on intermittent claudication of the cauda equina.

Acupuncture Therapy↗

Impact of ultrasonographic duplex scanning on therapeutic decision making in lower-limb arterial disease.

Ultrasonographic duplex scanning has become a valuable diagnostic technique in detecting and grading stenoses and occlusions of the aortoiliac and femoropopliteal arteries. However, the question remains as to whether a treatment strategy can be designed without diagnostic angiography. This prospective study evaluated the impact of duplex scanning on therapeutic decision making. Patients with intermittent claudication, rest pain or ischaemic ulceration of the lower limb who were eligible for invasive treatment were studied. If treatment was considered necessary, a duplex scan was performed instead of diagnostic angiography. The surgeon made a therapeutic decision based on clinical assessment and information obtained from the duplex scan. If it was felt that duplex scanning gave insufficient information, diagnostic angiography was then performed. A group of 112 consecutive patients were studied prospectively; 12 were excluded for logistical reasons. The 100 remaining patients (intermittent claudication in 69, rest pain in 16, ischaemic ulceration in 15) were evaluated. Based on non-invasive tests 22 patients were treated conservatively, 36 were scheduled for percutaneous transluminal angioplasty (PTA) and 32 were scheduled for surgery. Angiography was requested to determine the definitive treatment policy in 28 patients: four of the 22 were scheduled for conservative treatment and 24 of the 32 were scheduled for surgery. All PTAs were performed without prior diagnostic angiography. Angiography was considered necessary in a further ten patients to formulate a therapeutic strategy. In 62 patients the treatment strategy could be determined without diagnostic angiography. Twenty-three of the 39 angiograms performed did not give additional information on treatment strategy. Integrated use of duplex scanning for the investigation of patients with arterial occlusive disease of the lower limb can reduce the need for diagnostic angiography.

Aged↗

Peripheral arterial disease (PAD): secondary prevention.

SUMMARY: The prevalence of PAD rises as the population becomes increasingly older. At present, about 4.5 million citizens in Germany are estimated to be affected. In only one third of the patients intermittent claudication is found as a classical PAD marker. The course is thus predominantly asymptomatic. Consequently, careful evaluation of patients, including case history and pulse status as well as detailed recording of risk factors of atherosclerosis (chiefly smoking and diabetes mellitus), are important. When noninvasive methods of investigation is taken into account, the prevalence rises two- to three-fold. Duplex sonography with measurement of the ankle-brachial index (ABI) is a method which has so far not been used widely although it is highly accurate. Life expectancy of patients with PAD is shortened by about ten years. The prognosis is determined by the natural course of the disease in only a few patients (ischemia syndrome and/or ABI < 0.4). Patients are at much greater risk for cardiovascular and cerebrovascular incidents than of a systemic disease. Mortality is raised up to six fold by concomitant coronary heart disease. Therapy should therefore not only be designed to treat the peripheral, as well as the atherosclerosis. Like walk training under supervision, no smoking, optimal glycemic control in diabetic patients and restoration of the lipid status to normal are treatment measures that have proved to be effective. As for pharmacotherapy, the efficacy of thrombocyte aggregation inhibitors is regarded as proved, whereas many drugs targeting symptoms have yielded disappointing results in patients with intermittent claudication.

Adult↗

Regional Angiogenesis with Vascular Endothelial Growth Factor (VEGF) in peripheral arterial disease: Design of the RAVE trial.

BACKGROUND: Patients with intermittent claudication caused by infrainguinal atherosclerosis have limited pharmacologic options "Therapeutic angiogenesis" is a novel treatment approach that seeks to improve perfusion of ischemic limbs by the induction of collateral vessel formation. This trial is a phase 2 randomized double-blind placebo-controlled proof of concept trial that will use an intramuscular adenoviral gene transfer approach of vascular endothelial growth factor, 121 isoform (Ad(GV)VEGF(121.10)) to patients with severe IC caused by infrainguinal disease. METHODS: This is a phase 2, double-blind, randomized, placebo-controlled, dose-finding, multicenter study. Patients with severe intermittent claudication caused by infrainguinal atherosclerosis predominantly involving the superficial femoral artery confirmed with imaging studies that meet inclusion criteria will be stratified on the basis of the presence or absence of diabetes mellitus and randomized in a 1:1:1 fashion to low dose (4 x 10(9) particle units), high dose (4 x 10(10) particle units), or placebo arms (35-36 patients per group). Subjects are required to have exercise-limiting IC in the index extremity during 2 qualifying exercise treadmill tests, with peak walking times between 1 and 10 minutes. A single dose of Ad(GV)VEGF(121.10) will be administered as 20 intramuscular injections throughout the area of the lower limb requiring collateralization. RESULTS: The primary efficacy parameter for the Regional Angiogenesis With Vascular Endothelial Growth Factor (RAVE) trial is the change in peak walking time at 12 weeks compared with baseline. The sample size is expected to provide an 80% power to detect a difference of 1.5 minutes between any of the 2 treatment groups and the placebo group. Secondary efficacy parameters include claudication onset time, hemodynamic effects of therapy assessed with ankle-brachial index, assessment of physical impairment, and health-related quality of life as measured with the Walking Impairment Questionnaire and SF-36 Health Survey. All randomized patients will also be evaluated for safety.

Adenoviridae↗

[A case of spinal dural AVF treated by endovascular embolization].

Here we report a case of spinal dural arteriovenous fistula(AVF) treated by endovascular embolization. A 58-year-old female presented with progressive intermittent claudication and numbness of the lower extremities. MRI showed swelling of the spinal cord with intramedullary high signal intensity on T2-weighted image and intramedullary enhancement, suggested spinal cord myelopathy. Myelography demonstrated the dilated serpentine vessels in the subarachnoid space and focal filling defect. Angiography showed spinal dural AVF fed by bilateral lateral sacral artery. The draining vein was posterior spinal vein. Endovascular embolization using liquid material was performed under general anesthesia. The injection of glue included the distal feeding artery, the shunt itself and the initial part of draining vein. A complete cure was achieved, with a normal postoperative angiogram. MRI returned to normal with complete disappearance of T2 high signal, cord enlargement and enhancement by contrast medium. It was suggested that venous congestion induced the transient spinal ischemia, manifested as intermittent claudication. Endovascular embolization using liquid material was safe and quite effective for spinal dural AVF.

Central Nervous System Vascular Malformations↗

Effects of beraprost sodium (Dorner) in patients with diabetes mellitus complicated by chronic arterial obstruction.

The effects of the prostaglandin I2 derivative beraprost sodium (Dorner) on ankle pressure index (AP; ankle joint-to-upper extremity systolic pressure ratio), subjective symptoms, and intermittent claudication were investigated in diabetic patients with arteriosclerosis obliterans (ASO). Forty patients (25 men and 15 women), mean age 63.9 years, were enrolled in this study. ASO was grade I in 30 patients, grade II in seven, grade III in one, and grade IV in two according to the Fontaine classification. They were administered six tablets (20 microg/tablet) of beraprost sodium daily for 6 months. At 3 and 6 months, API had significantly increased and symptoms such as coldness, numbness, and lack of feeling in the lower extremities were significantly improved. Ten evaluable patients increased ambulatory distance by approximately threefold, suggesting an improvement in intermittent claudication. Adverse reactions were experienced by five (12.5%) of the 40 patients (one case each of headache, dull headache, pain in the posterior region of the neck, heartburn, stomach discomfort, and anemia), but all were mild and resolved without treatment. Beraprost sodium was shown to improve API and symptoms in the lower extremities in diabetic patients with ASO, suggesting that it is useful in treating peripheral circulatory disorders in such patients.

Aged↗