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Intermittent Claudication (intermittent + claudication)

Distribution by Scientific Domains

Medical Sciences	96%

Distribution within Medical Sciences

Surgery & Surgical Specialties	52%
Neurology	15%

Selected Abstracts

Measurement of ischaemia,reperfusion in patients with intermittent claudication using NMR-based metabonomics

NMR IN BIOMEDICINE, Issue 7 2008
Stefan A. Coolen
Abstract Intermittent claudication has proved to be a good in vivo model for ischaemia,reperfusion. For assessment of ischaemia,reperfusion damage, the known biochemical markers all have disadvantages with respect to sensitivity and interference with other physiological events. In this work, we studied the metabolic effects of ischaemia,reperfusion in patients with intermittent claudication, and the effects of vitamin C and E intervention, using both traditional biochemical measurements and 1H-NMR-based metabonomics on urine and plasma. The 1H-NMR spectra were subjected to multivariate modelling using principal components discriminant analysis, and the observed clusters were validated using joint deployment of univariate analysis of variance and Tukey,Kramer honestly significant difference (HSD) testing. The study involved 14 patients with intermittent claudication and three healthy volunteers, who were monitored during a walking test, before and after a vitamin C/E intervention, and after a washout period. The effect of exercise was only observable for a limited number of biochemical markers, whereas 1H NMR revealed an effect in line with anaerobic ATP production via glycolysis in exercising (ischaemic) muscle of the claudicants. Thus, the beneficial effect of vitamins C and E in claudicants was more pronounced when observed by metabonomics than by traditional biochemical markers. The main effect was more rapid recovery from exercise to resting state metabolism. Furthermore, after intervention, claudicants tended to have lower concentrations of lactate and glucose and several other citric acid cycle metabolites, whereas acetoacetate was increased. The observed metabolic changes in the plasma suggest that intake of vitamin C/E leads to increased muscle oxidative metabolism. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Randomized double-blind placebo-controlled crossover study of caffeine in patients with intermittent claudication,

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 10 2010
A. H. Momsen
Background: Intermittent claudication is a disabling symptom of peripheral arterial disease for which few medical treatments are available. This study investigated the effect of caffeine on physical capacity in patients with intermittent claudication. Methods: This randomized double-blind placebo-controlled crossover study included 88 patients recruited by surgeons from outpatient clinics. The participants abstained from caffeine for 48 h before each test and then received either a placebo or oral caffeine (6 mg/kg). After 75 min, pain-free and maximal walking distance on a treadmill, perceived pain, reaction times, postural stability, maximal isometric knee extension strength, submaximal knee extension endurance and cognitive function were measured. The analysis was by intention to treat. Results: Caffeine increased the pain-free walking distance by 20·0 (95 per cent confidence interval 3·7 to 38·8) per cent (P = 0·014), maximal walking distance by 26·6 (12·1 to 43·0) per cent (P < 0·001), muscle strength by 9·8 (3·0 to 17·0) per cent (P = 0·005) and endurance by 21·4 (1·2 to 45·7) per cent (P = 0·004). However, postural stability was reduced significantly, by 22·1 (11·7 to 33·4) per cent with eyes open (P < 0·001) and by 21·8 (7·6 to 37·8) per cent with eyes closed (P = 0·002). Neither reaction time nor cognition was affected. Conclusion: In patients with moderate intermittent claudication, caffeine increased walking distance, maximal strength and endurance, but affected balance adversely. Registration number: NCT00388128 (http://www.clinicaltrials.gov). Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Peripheral arterial disease in diabetes,a review

DIABETIC MEDICINE, Issue 1 2010
E. B. Jude
Diabet. Med. 27, 4,14 (2010) Abstract Diabetic patients are at high risk for peripheral arterial disease (PAD) characterized by symptoms of intermittent claudication or critical limb ischaemia. Given the inconsistencies of clinical findings in the diagnosis of PAD in the diabetic patient, measurement of ankle-brachial pressure index (ABI) has emerged as the relatively simple, non-invasive and inexpensive diagnostic tool of choice. An ABI < 0.9 is not only diagnostic of PAD even in the asymptomatic patient, but is also an independent marker of increased morbidity and mortality from cardiovascular diseases. With better understanding of the process of atherosclerosis, avenues for treatment have increased. Modification of lifestyle and effective management of the established risk factors such as smoking, dyslipidaemia, hyperglycaemia and hypertension retard the progression of the disease and reduce cardiovascular events in these patients. Newer risk factors such as insulin resistance, hyperfibrinogenaemia, hyperhomocysteinaemia and low-grade inflammation have been identified, but the advantages of modifying them in patients with PAD are yet to be proven. Therapeutic angiogenesis, on the other hand, represents a promising therapeutic adjunct in the management of PAD in these patients. Outcomes after revascularization procedures, such as percutaneous transluminal angioplasty and surgical bypasses in diabetic patients, are poorer, with increased perioperative morbidity and mortality compared with that in non-diabetic patients. Amputation rates are higher due to the distal nature of the disease. Efforts towards increasing awareness and intensive treatment of the risk factors will help to reduce morbidity and mortality in diabetic patients with PAD. [source]

Mild peripheral neuropathy prevents both leg muscular ischaemia and activation of exercise-induced coagulation in Type 2 diabetic patients with peripheral artery disease

DIABETIC MEDICINE, Issue 10 2007
F. Piarulli
Abstract Aim, To study the influence of peripheral neuropathy on intermittent claudication in patients with Type 2 diabetes (T2DM). Methods, Twenty-five patients with T2DM were grouped according to the ankle/brachial index (ABI): 10 with ABI > 0.9 without peripheral artery disease (PAD; group T2DM) and 15 with ABI < 0.9 with PAD (group T2DM + PAD). Twelve individuals without T2DM with PAD (group PAD without T2DM) were also enrolled. Tests for peripheral neuropathy were performed in all patients. ABI, rate pressure product, prothrombin fragments 1 + 2 (F1+2), thrombin-anti-thrombin complex (TAT), and d -dimer were measured before and after a treadmill test. During exercise both initial and absolute claudication distance and electrocardiogram readings were recorded. Results, We found mild peripheral neuropathy in 20% of group T2DM and 46.7% of group T2DM + PAD (P < 0.01). After exercise, the rate pressure product increased in each group; ABI fell in T2DM + PAD (P < 0.0001) and in PAD without T2DM (P = 0.0005); the fall was greater in the latter group. Initial and absolute claudication distances were similar in PAD patients. In group T2DM + PAD, absolute claudication distance was longer in the subgroup without peripheral neuropathy (P < 0.05), whereas ABI and rate pressure products were similar. F1+2 values at rest were higher in group T2DM + PAD. After exercise, F1+2 values and TAT increased only in group PAD without T2DM. Conclusion, Only group PAD without T2DM experienced muscular ischaemia, whereas group T2DM + PAD did not. Mild peripheral neuropathy may have prevented them from reaching the point of muscular ischaemia during the treadmill test, because they stopped exercising with the early onset of pain. Reaching a false absolute claudication distance may induce ischaemic preconditioning. These findings suggest a possible protective role of mild peripheral neuropathy in T2DM patients with intermittent claudication, by preventing further activation of coagulation during treadmill testing. [source]

Heart and carotid artery disease in stroke patients with intermittent claudication

EUROPEAN JOURNAL OF NEUROLOGY, Issue 5 2000
X. F. Liu
Much has been published on the natural history of intermittent claudication (IC), but little is known about the clinical features of stroke patients with IC. The purpose of this study was to examine clinical features and risk factors in stroke patients with or without IC, including heart disease and carotid artery disease. A hospital-based study was conducted of 3901 stroke patients, who were prospectively coded and entered into a computerized databank. Of these patients, 219 had symptoms of IC. Patients were subdivided by age into 10-year categories. There were at least 12 times more non-IC than IC patients in each category. An age-matched random sample was obtained containing 12 non-IC cases for each IC case, resulting in 219 cases of IC and 2628 non-IC cases. The prevalence of IC in the total stroke population was 5.6%. IC prevalence increased sharply with age until about 70 years. Cardiac ischaemia and internal carotid artery (ICA) disease were significantly more frequent in stroke with IC than without IC. IC patients also exhibited a higher prevalence of atherosclerotic disease as well as other risk factors such as smoking, hypercholesterolaemia, elevated haematocrit, and family history of stroke. Ischaemic heart disease and ICA disease are especially common in stroke with IC. IC, large artery disease and stroke share similar risk factors. IC symptoms in stroke patients may indicate extensive generalized atherosclerosis. [source]

Ineffective Peripheral Tissue Perfusion: Clinical Validation in Patients With Hypertensive Cardiomiopathy

INTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2 2006
Rita de Cassia Gengo de Silva MS
PURPOSE.,To validate defining characteristics of ineffective peripheral tissue perfusion using vasomotor function assessment. METHODS.,Twenty-four patients with hypertensive cardiomiopathy were evaluated for 18 defining characteristics of ineffective peripheral tissue perfusion and underwent vasomotor function assessment with induction of reactive hyperemia, intra-arterial infusion of acetylcholine, and pulse wave velocity measurement. The Student's t test and Kruskall,Wallis test were used to assess the significance of relationships between defining characteristics and vasomotor function data. FINDINGS.,Diminished lower extremity pulses were associated with diminished forearm blood flow during acetylcholine infusion; left ventricular overload, intermittent claudication, and diminished skin moisture were associated with elevated pulse wave velocity values. CONCLUSION.,The defining characteristics of ineffective peripheral tissue perfusion were highly associated with vasomotor function data as "gold standards" for that diagnosis. PRACTICE IMPLICATIONS.,Nurses should be able to accurately assess diminished lower extremity pulses, intermittent claudication, and diminished skin moisture as relevant characteristics of ineffective peripheral tissue perfusion in patients with hypertensive cardiomiopathy. Irrigation Tissulaire Périphérique Inefficace: Validation Clinique Chez les Patients Atteints de Cardiomyopathie Hypertensive BUT.,Valider les caractéristiques de Irrigation tissulaire périphérique inefficace en utilisant l'évaluation de la fonction vasomotrice. MÉTHODES.,Vingt-quatre patients souffrant de cardiomyopathie hypertensive furent évalués au regard des 18 caractéristiques du diagnostic Irrigation vasculaire périphérique inefficace et de la fonction vasomotrice par induction d'une hyperémie réactionnelle, la perfusion intra-artérielle d'acétylcholine, et la mesure de la vélocité de l'onde du pouls. Les tests "Student t et Kruskall,Wallis" furent utilisés pour déterminer l'importance des liens entre les caractéristiques et les valeurs de la fonction vasomotrice. RÉSULTATS.,La diminution des pulsations périphériques des membres inférieurs fut associée à une diminution du flot sanguin pendant la perfusion d'acétylcholine; une surcharge ventriculaire gauche, de la claudication intermittente et une diminution de l'hydratation de la peau furent associées à des valeurs élevées de la vélocité de l'onde du pouls. CONCLUSION.,,Les caractéristiques de Irrigation tissulaire périphérique inefficace qui furent associées de manière significative à la fonction vasomotrice peuvent être considérées comme les "étalons or" de ce diagnostic. IMPLICATIONS POUR LA PRATIQUE.,Les infirmières devraient être capables d'évaluer correctement la diminution des pouls périphériques, la claudication intermittente, et la diminution de l'hydratation de la peau, car ce sont des caractéristiques pertinentes de l'irrigation tissulaire périphérique inefficace chez les patients atteints de cardiomyopathie hypertensive. Translation by Cécile Boisvert, MSN, RN Perfusão Tissular Periférica Ineficaz: Validação Clínica em Pacientes com Miocardiopatia Hipertensiva PROPÓSITO.,Validar as caraterísticas definidoras do diagnóstico de perfusão tissular periférica ineficaz usando a avaliação da função vasomotora. MÉTODO.,Vinte e quatro pacientes com miocardiopatia hipertensiva foram avaliados segundo 18 características definidoras de perfusão tissular periférica ineficaz e submetidos a avaliação da função vasomotora por indução de hiperemia reativa, infusão intra-arterial de acetilcolina e por mensuração da velocidade da onda de pulso. Testes T de Student e de Kruskall,Wallis foram aplicados para avaliar a significância das relações entre as características definidoras e os dados da função vasomotora. RESULTADOS.,Diminuição de pulso nas extremidades inferiores foi associada com o menor fluxo de sangue no antebraço durante a infusão de acetilcolina; sobrecarga ventricular esquerda, claudicação intermitente e diminuição da hidratação da pele foram associados com valores elevados de velocidade de onda de pulso. CONCLUSÃO.,Quatro características definidoras de perfusão tissular periférica ineficaz foram altamente associadas com função vasomotora alterada como "padrão ouro" para este diagnóstico. IMPLICAÇÕES PARA A PRÁTICA.,As enfermeiras devem ser capazes de avaliar com precisão a diminuição dos pulsos das extremidades inferiores, claudicação intermitente e diminuição na hidratação da pele como características definidoras relevantes da perfusão tissular periférica ineficaz em pacientes com miocardiopatia hipertensiva. Translation by Alba Leite de Barros, PhD, RN Perfusión Tisular Periférica Inefectiva: Validación Clínica en Pacientes que Presentan Miocardiopatía Hipertensiva PROPÓSITO.,Validar las características definitorias del diagnóstico Perfusión tisular periférica inefectiva utilizando una valoración de la función vasomotora. METODOLOGÍA.,Veinticuatro pacientes diagnosticados de Miocardiopatía Hipertensiva fueron evaluados con respecto a las 18 características definitorias del diagnóstico Perfusión tisular periférica inefectiva y sometidos a una valoración de la función vasomotora con inducción de Hiperemia reactiva, infusión intra-arterial de acetilcolina, y medida de la velocidad de la onda del pulso. Se utilizaron los análisis estadísticos de t-Student y Kruskall,Wallis para valorar el significado de las relaciones entre las características definitorias y los datos obtenidos de la valoración de la función vasomotora. HALLAZGOS.,Durante la infusión de acetilcolina se detectó disminución de los pulsos en la extremidad inferior relacionado con la disminución del volumen de sangre en el antebrazo; la sobrecarga ventricular izquierda, claudicación intermitente y disminución de la hidratación de la piel fueron asociadas con la elevación de los valores de la velocidad de la onda del pulso. CONCLUSIÓN.,Las características definitorias del diagnóstico Perfusión tisular periférica inefectiva estaban fuertemente asociadas a los datos procedentes de la valoración de la función vasomotora identificándose como "estándares fundamentales" para este diagnóstico. IMPLICACIONES PARA LA PRÁCTICA.,Las enfermeras deberían ser capaces de valorar cuidadosamente la presencia de pulsos disminuidos en las extremidades inferiores, y la disminución de la hidratación de la piel ya que son características relevantes del diagnóstico Perfusión tisular periférica inefectiva en pacientes que presentan Miocardiopatía Hipertensiva. Translation by Adolf Guirao, RN [source]

Effects of 5-HT2A receptor antagonist on blood flow in chronically compressed nerve roots

JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 4 2004
Miho Sekiguchi
Abstract Neurogenic intermittent claudication (NIC) can be caused by compression of the cauda equina by spinal stenosis and is a major clinical problem. A reduction of blood flow is an important mechanism for inducing NIC and may be caused by a vasoconstrictive effect mediated by the serotonin 5-HT2A receptor in chronic cauda equina compression lesions. This study assessed the effects of the 5-HT2A receptor antagonist on nerve vasculature in chronically compressed nerve roots. A plastic balloon was placed under the lamina of L7 and inflated to 10 mmHg and left for 1 week in several cauda equina compression models. All experimental animals received an acute administration of serotonin. One group received sarpogrelate hydrochloride (5-HT2A receptor antagonist: 5-HTRA) before administration of serotonin, and another group was administered 5-HTRA after administration of serotonin. Diameters and blood flow in the vasculature of S2 or S3 nerve roots were measured after injection of serotonin. In animals without compression of the cauda equina (sham), blood vessels contracted and the blood flow was reduced after administration of serotonin. In sham and compression animals receiving both serotonin and 5-HTRA, blood vessel diameter was not reduced and was significantly larger than that in the compression group receiving only serotonin (p < 0.05). Likewise, the blood flow was not reduced in sham and compression animals receiving serotonin and 5-HTRA and was significantly greater in the compression group treated only with serotonin. 5-HTRA inhibited vasoconstriction and the reduction of blood flow in chronically compressed nerve roots challenged with serotonin. This fact suggests that 5-HTRA might be effective at improving blood flow in chronically compressed nerve roots in patients with spinal canal stenosis and changes in circulation levels of serotonin. [source]

Epidural Neurostimulation of Posterior Funiculi for the Treatment of Buerger's Disease

NEUROMODULATION, Issue 2 2009
Lorena Vaquer Quiles
ABSTRACT Background., Buerger disease is a nonatherosclerotic, segmental, occlusive and recurrent inflammatory vascular disorder that affects small and medium-sized arteries and veins of the upper and lower extremities. Case reports., We report two cases of Buerger disease. Medical History., Smoking habit. No autoimmune diseases. No diabetes mellitus. Intermittent vascular claudication at 100,150 m. Several hospital admissions for amputations. Prior Medical Treatment., Antiplatelet agents, vasodilators, nonsteroidal anti-inflammatory drugs, third-step analgesics, fibrinolytic treatment and lumbar sympathectomies. Following all of the above treatments, Synergy®spinal cord (ECP) stimulator with two electrodes (Quad PISCES©) placed at the level of T9,T10. Results., There has been a reduction in pain of about 80% and an improvement of intermittent claudication (one of the patients no longer claudicates, whereas the other patient claudicates at 400 m). Conclusion., Neurostimulation of the posterior funiculi could be considered not only as palliative care but also as a therapeutic option. [source]

Measurement of ischaemia,reperfusion in patients with intermittent claudication using NMR-based metabonomics

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PRESCRIBER, Issue 10 2008
Article first published online: 3 JUN 200
Glitazones more than double fracture risk An analysis of the UK General Practice Research Database has found that both glitazones increase the risk of fracture more than two-fold (Arch Intern Med 2008;168:820-5). Compared with nonusers, the odds ratio for fracture (mostly hip and wrist) was 2.59 for pioglitazone and 2.38 for rosiglitazone. The risk increased with dose but was unrelated to age and sex. Reduce antipsychotics in dementia patients Antipsychotics should be prescribed for patients with dementia only as a last resort at times of severe distress or critical need, the All-Party Parliamentary Group on Dementia has concluded. Its inquiry (available at www.alzheimers.org.uk) found that antipsychotics are being prescribed for patients with mild behavioural symptoms and for prolonged periods despite the limited benefits they offer and the risk of serious adverse effects such as stroke. Contributory factors include lack of training for staff, inadequate leadership and exclusion of family and friends from decisions about treatment. High-dose atorvastatin in chronic kidney disease High-dose atorvastatin (Lipitor) reduces cardiovascular events in patients with chronic kidney disease (CKD) more than a low dose , despite similar reductions in LDL-C (J Am Coll Cardiol 2008;51:1448-54). A post hoc subgroup analysis of the Treating-to-New-Targets study involving 10 001 patients with CHD, with or without CKD, found that atorvastatin 10 and 80mg per day reduced LDLC and triglycerides to similar levels; there was no change in HDL-C. After a median follow-up of five years, the incidence of cardiovascular events in patients with CKD was 9.3 per cent at 80mg per day and 13.4 per cent at 10mg per day (number needed to treat to prevent one event, NNT, 24). In patients with no CKD, the corresponding figures were 7.9 vs 9.2 per cent (NNT 74). There was no difference in all-cause mortality; adverse events were more frequent at the higher dose. COX-2 NSAIDs not more cost-effective An economic analysis of COX-2 selective NSAIDs has concluded that they are not more cost effective than older agents plus a proton pump inhibitor (PPI) in the treatment of osteoarthritis and rheumatoid arthritis (Health Technology Assessment 2008;12:No. 11). The analysis concluded that selective and nonselective NSAIDs were similarly effective but selective agents were associated with a lower risk of upper GI events and a higher risk of cardiovascular events. However, the available evidence includes only low numbers of events and further studies are needed. Compared with ibuprofen or diclofenac plus a PPI, the COX-2 selective NSAIDs look ,generally unattractive from a cost effectiveness point of view', even in high-risk patients with a history of peptic ulcer. There were insufficient data to allow a reliable comparison within the COX-2s. Naftidrofuryl helps intermittent claudication Naftidrofuryl increases pain-free walking distance (PFWD) in patients with intermittent claudication, a new Cochrane review has shown (Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD001368. DOI: 10.1002/ 14651858.CD001368.pub3; also see page 49 in this issue). The meta-analysis of six trials involving a total of 1083 patients found that, compared with placebo, naftidrofuryl increased PFWD by over a third with a proportion successfully treated of 20 per cent (NNT 4.5). Coversyl Arginine To clarify any confusion following our recent news item (Perindopril brand switch, 19 April issue, page 12), Servier has asked us to reiterate that the new formulations Coversyl Arginine 2.5, 5 and 10mg are equivalent to 2, 4 and 8mg of the discontinued Coversyl formulation. Coversyl Arginine contains perindopril arginine, a salt that offers greater stability and a longer shelf-life. Prescriptions for the Coversyl brand of perindopril must in future be written as Coversyl Arginine in its revised strengths. Coversyl Plus has also been replaced by Coversyl Arginine Plus and the same revised dosages apply. Generic formulations of perindopril remain unaffected. Copyright © 2008 Wiley Interface Ltd [source]

,-Adrenergic inhibition increases collateral circuit conductance in rats following acute occlusion of the femoral artery

THE JOURNAL OF PHYSIOLOGY, Issue 6 2008
Jessica C. Taylor
This study evaluated whether ,-adrenergic activation contributes to collateral circuit vascular resistance in the hindlimb following acute unilateral occlusion of the femoral artery in rats. Blood pressures (BPs) were measured above (caudal artery) and below (distal femoral artery) the collateral circuit. Arterial BPs were reduced (15,35 mmHg) with individual (prazosin, rauwolscine) or combined (phentolamine) ,-receptor inhibition. Blood flows (BFs) were measured using microspheres before and after , inhibition during the same treadmill speed. ,1 inhibition increased blood flow by ,40% to active muscles that were not affected by femoral occlusion, whereas collateral-dependent BFs to the calf muscles were reduced by 29 ± 8.4% (P < 0.05), due to a decrease in muscle conductance with no change in collateral circuit conductance. ,2 inhibition decreased both collateral circuit (39 ± 6.0%; P < 0.05) and calf muscle conductance (36 ± 7.3%; P < 0.05), probably due to residual ,1 activation, since renal BF was markedly reduced with rauwolscine. Most importantly, inhibiting ,2 receptors in the presence of ,1 inhibition increased (43 ± 12%; P < 0.05) collateral circuit conductance. Similarly, non-selective , inhibition with phentolamine increased collateral conductance (242 ± 59%; P < 0.05). We interpret these findings to indicate that both ,1 - and ,2 -receptor activation can influence collateral circuit resistance in vivo during the high flow demands caused by exercise. Furthermore, we observed a reduced maximal conductances of active muscles that were ischaemic. Our findings imply that in the presence of excessive sympathetic activation, which can occur in the condition of intermittent claudication during exertion, an exaggerated vasoconstriction of the existing collateral circuit and active muscle will occur. [source]

THE CONUNDRUM OF CLAUDICATION

ANZ JOURNAL OF SURGERY, Issue 10 2006
Ramon L. Varcoe
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. [source]

Randomized double-blind placebo-controlled crossover study of caffeine in patients with intermittent claudication,

Case,control comparison of profundaplasty and femoropopliteal supragenicular bypass for peripheral arterial disease,

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2010
A. Koscielny
Background: The aim of this study was to compare preoperative and postoperative findings, and clinical progress in patients with peripheral arterial occlusive disease undergoing femoropopliteal supragenicular bypass or profundaplasty in a case,control study. Methods: Between January 2001 and June 2004, 171 patients with occlusion of the superficial femoral artery underwent surgery. A retrospective analysis of 28 matched patient pairs was performed. Endpoints were bypass occlusion, surgical revision, amputation and death. Mean length of follow-up was 36 months. Results: At 3 years after surgery there was no statistically significant difference in outcome between femoropopliteal bypass surgery and profundaplasty. There was a trend towards improved results in patients who had bypass surgery for critical leg ischaemia. Preoperative patency of the crural outflow arteries was an independent prognostic factor in multivariable analysis. Conclusion: There were no significant outcome differences between supragenicular bypass surgery or profundaplasty in patients who had surgery for intermittent claudication or ischaemic rest pain. Patients with a single patent tibial artery and gangrene or ulceration appeared to benefit more from bypass surgery. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

A RCT of non-surgical treatment for intermittent claudication in femoro-popliteal disease: 12-month results

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue S1 2009
F. A. K. Mazari
No abstract is available for this article. [source]

Fibrinolytic risk factor clustering and insulin resistance in healthy male relatives of men with intermittent claudication,

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2006
D. J. Parry
Background: Raised fibrinolytic factors predict cardiovascular risk in healthy subjects. The aim of this study was to measure fibrinolytic factors and insulin resistance in healthy male first-degree relatives of men with intermittent claudication younger than 65 years. Methods: The study compared 165 healthy first-degree relatives with 165 age-, sex- and race-matched control subjects free from a personal or family history of premature cardiovascular disease. Primary outcome measures were plasminogen activator inhibitor 1 (PAI-1), tissue plasminogen activator (tPA) and D-dimer levels. Insulin resistance was estimated by Homeostasis Model Assessment. Clinical and biochemical risk factors were measured and subjects genotyped for the PAI-1 4G/5G polymorphism. Results: First-degree relatives had significantly higher mean PAI-1 (10·23 versus 7·85 ng/ml; P = 0·024), tPA (9·98 versus 8·29 ng/ml; P < 0·001) and D-dimer levels (56·6 versus 46·1 ng/ml; P = 0·004). They also had significantly higher insulin resistance (1·85 versus 1·53; P < 0·001) and clustered multiple atherogenic risk factors. On multivariate analysis the association between both tPA and D-dimer levels and relative status was independent of other variables. Conclusion: Raised levels of PAI-1, tPA, D-dimer and estimated insulin resistance were present in the healthy male first-degree relatives of men with intermittent claudication. These data support the hypothesis of fibrinolytic risk factor clustering in this high-risk population. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Management of intermittent claudication

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 5 2002
C. P. Shearman
No abstract is available for this article. [source]

Near-infrared spectroscopy grades the severity of intermittent claudication in diabetics more accurately than ankle pressure measurement,

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2000
Dr T. Komiyama
Background: The aim of this study was to evaluate near-infrared spectroscopy (NIRS), combined with a treadmill-walking test, as a method of assessment of intermittent claudication (IC) in diabetic patients. Methods: Some 208 symptomatic legs in 153 consecutive patients who complained of calf IC due to atherosclerotic disease were studied with NIRS and resting ankle: brachial pressure index (ABPI). Results: There was good reproducibility of NIRS measurements. Three distinct types of IC were detected by NIRS. ABPI was significantly different between these three types in non-diabetic patients, but could not grade the severity of IC in diabetic patients. Recovery time (RT) of muscle oxygenation differentiated more accurately between severe and moderate claudication than ABPI in diabetics, although RT and ABPI had similar accuracy in non-diabetics. There was a significant correlation between RT and ABPI in non-diabetic patients and patients who had been diabetic for less than 10 years, while there was no correlation in patients who had had diabetes for over 10 years. Conclusion: Measurement of muscle oxygenation during exercise by NIRS graded the severity of IC in diabetic patients more accurately than resting ABPI. © 2000 British Journal of Surgery Society Ltd [source]

Prevalence and treatment of hypercholesterolaemia in patients with peripheral vascular disease

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2000
S. M. Evans
Background: Hypercholesterolaemia is a recognized risk factor for the development of arteriosclerosis. There is compelling evidence to support the use of lipid-lowering strategies in all hypercholesterolaemic patients with arteriosclerotic disease. In peripheral arterial disease (PAD), national guidelines recommend treatment if total cholesterol exceeds 5·0 mmol l,1. The prevalence of hypercholesterolaemia in patients with PAD was determined and the adequacy of lipid management before vascular referral was examined. Methods: This was a prospective study of 233 consecutive patients admitted electively to this vascular surgery unit between December 1997 and December 1998. Some 68 patients were admitted with carotid disease, 81 with an aneurysm and 84 with intermittent claudication. A fasting venous blood sample was obtained from each patient. Results: There were 175 men and 58 women, of median age 67 (range 37,85) and 68 (range 47,85) years respectively. Only 35 patients (15 per cent) were previously known to be hypercholesterolaemic; all but one were receiving treatment (one dietary, 33 statin). Of the remaining 198 patients, 124 (63 per cent) had a serum cholesterol level above 5·0 mmol l,1. A further 17 patients (9 per cent) had total cholesterol/high-density lipoprotein: cholesterol ratio greater than 5·0; these patients may also benefit from lipid-lowering therapy. In total, 141 (80 per cent) of 176 hypercholesterolaemic patients were undiagnosed at the time of hospital admission. Conclusion: Hypercholesterolaemia is an important and correctable risk factor found in the majority of patients with PAD, but despite national guidelines and clear evidence from randomized controlled trials it is simply not being diagnosed in primary care. All elective patients with PAD should be screened for hypercholesterolaemia during their admission. © 2000 British Journal of Surgery Society Ltd [source]

Impact of intravascular ultrasound for the treatment of calcified infrarenal aortic stenosis: A case report study,

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 6 2008
Masahiko Hara MD
Abstract We report two cases of heavily calcified infrarenal aortic stenosis that were successfully treated by Intravascular ultrasound- (IVUS)-guided stenting. Two middle-aged women visited our hospital due to intermittent claudication. Diagnostic arteriography revealed possible infrarenal aortic stenosis even though the findings were equivocal. IVUS demonstrated heavily calcified atherosclerotic lesions and allowed the accurate assessment of the types and extents of the lesions to be treated in both cases. The patients successfully underwent stent implantation according to the findings of IVUS. IVUS significantly contributed to the interventional successes. © 2008 Wiley-Liss, Inc. [source]