Peripheral arterial disease claudication

Peripheral arterial disease (claudication or ankle-brachial index less than 0.9)... 

TREATMENT OF PERIPHERAL ARTERY DISEASE AND INTERMITTENT CLAUDICATION... 

Atherosclerosis can result in ischemia of peripheral muscles just as coronary artery disease causes cardiac ischemia. Pain (claudication) occurs in skeletal muscles, especially in the legs, during exercise and disappears with rest. Although claudication is not immediately life-threatening, peripheral artery disease is associated with increased mortality, can severely limit exercise tolerance, and may be associated with chronic ischemic ulcers and susceptibility to infection. 

Radack K, Deck C, Beta-adrenergic blocker therapy does not worsen intermittent claudication in subjects with peripheral arterial disease, a meta-analysis of randomized controlled trials. Arch Intern Med 1991 151 1769— 1776. 

Regensteiner JG, WareJrJE, McCarthy WJ, etal. Effect of cilostazol on treadmill walking, community-based walking ability, and health-related quality of life in patients with intermittent claudication due to peripheral arterial disease meta-analysis of six randomized controlled trials. J Am Geriatr Soc 2002 50 1939-1946. 

Comp PC. Treatment of intermittent claudication in peripheral arterial disease. Recent clinical experience with cilostazol. Today s Ther Trends 1999 17 99-112. 

The clinical presentation of peripheral arterial disease is variable and includes a range of symptoms. The two most common characteristicsof peripheral arterial disease are intermittent claudication and pain at rest in the lowerextremities. 

Hiatt WR. Medical treatment of peripheral arterial disease and claudication. N Engl J Med 2001 344 1608-1621. 

Group TW. Management of peripheral arterial disease (PAD). Trans-Atlantic Inter-Society Consensus (TASC). Section B intermittent claudication. Euro J Vase Endovasc Surg 2000 19(Suppl A) S47-S 114. 

Hiatt WR. Pharmacologic therapy for peripheral arterial disease and claudication. J Vase Surg 2002 36 1283-1291. 

Gardner AW, Katzel LI, Sorkin JD, Goldberg AP. Effects of long-term exercise rehabilitation on claudication distances in patients with peripheral arterial disease a randomized controlled trial. J Cardiopulm Rehabil 2002 22 192-198. 

Peripheral arterial disease (PAD)—Atherosclerotic occlusive disease of the extremities, usually diagnosed by symptoms (claudication) or assessment of the blood flow to an extremity. 

Many patients with advanced peripheral arterial disease are more limited by the consequences of peripheral ischemia than by myocardial ischemia. In the cerebral circulation, arterial disease may be manifest as stroke or transient ischemic attacks. The painful symptoms of peripheral arterial disease in the lower extremities (claudication) typically are provoked by exertion, with increases in skeletal muscle O2 demand exceeding blood flow impaired by proximal stenoses. When flow to the extremities becomes critically limiting, peripheral ulcers and rest pain from tissue ischemia can become debilitating. 

Ticlopidine (29) is equally effective in both men and woman and also improves symptoms of claudication in patients with peripheral arterial disease and appears to reduce anginal pain. Patients with subarchnoid haemorrhage and sickle cell disease have shown some improvement with ticlopidine administration. 

Hiatt WR, Hirsch AT, Creager MA, Rajagopalan S, Mohler ER, Ballantyne CM, Regensteiner JG, Treat-Jacobson D, Dale RA. Effect of niacin ER/lovastatin on claudication symptoms in patients with peripheral artery disease. Vase Med 2010 15 171-9. 

Peripheral arterial occlusion can be the initial manifestation of cardiac or systemic disease. At times, patients with chronic stable claudication may experience abrupt shortening of the distance at which claudication occurs, and this may be the only symptomatic evidence of an acute arterial occlusion either by embolization of by thrombus formation on a pre-existing arterial stenosis. The situation is not chronic and stable any more, but acute and unstable. As ischemia becomes more severe, the patient with chronic peripheral arterial disease develops ischemic pain at rest. The pathophysiologic mechanisms and the clinical presentation parallel the evolution of chronic stable angina pectoris to unstable angina and acute coronary syndromes. 

For large vessel peripheral arterial disease, cigaret smoking is the most important risk factor (22). Surgical revascularization is significantly less effective in reducing long-term symptoms of claudication if patients continue to smoke. 

Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis affecting 18 to 20% of the population over age 75 (7,2). By the late fifth decade almost 8% demonstrate significant asymptomatic disease on noninvasive testing, whereas 5% have symptoms of intermittent claudication, which is a major manifestation (3). This is caused by muscle ischemia secondary to inadequate blood flow that is unable to meet oxygen demands during exercise. Intermittent claudication can lead to moderate to severe impairment in the patient s walking ability. 

Aronow WS, Nayuk D, Woodworth S, et al. Effects of simvastatin versus placebo on treadmill exercise time until the onset of intermittent claudication in older patients with peripheral arterial disease at six months and at one year after treatment. Am J Cardiol 2003 92 711-772. 

Hirsch AT. Claudication as an orphan disease rationale and goals of drug therapy for peripheral arterial disease. Viasc Med 1996 1 37-42. 

---