The health-related quality of life of people with peripheral arterial disease in the community: the Edinburgh Artery Study.

BACKGROUND: Previous studies investigating the health-related quality of life of those with peripheral arterial disease have focused on patients recruited from hospital clinics. The health-related quality of life of people with peripheral arterial disease in the general population is unknown. AIMS: We aimed to determine the health-related quality of life of people with intermittent claudication and asymptomatic peripheral arterial disease in the general population and to compare it with those with angina and those with no peripheral arterial disease or angina.Design of study: Analysis of cross-sectional data from the 12-year follow-up of a population-based cohort. SETTING: Edinburgh, Scotland. METHOD: Data from the Edinburgh Artery Study cohort's 12-year follow-up was analysed. Participants' peripheral arterial disease status was measured using the World Health Organisation intermittent claudication questionnaire and the ankle brachial pressure index. Self-assessed health-related quality of life data was collected using the SF-36 generic questionnaire. Health-related quality of life scores were calculated and their associations with peripheral arterial disease status groups were tested. RESULTS: Subjects with intermittent claudication had significantly worse median health-related quality of life scores than patients without claudication in all domains except social functioning and mental health. Patients with claudication had a significantly lower physical component summary score than those without claudication (P 相似文献   

Pathophysiology and diagnosis for arteriosclerosis obliterans

Patients with arteriosclerosis obliterans, or peripheral arterial disease have been conventionally diagnosed and treated from only the viewpoint of peripheral arterial circulation. These concepts may have improved the quality of life for patients, but could not contribute the prognosis of life, because peripheral arterial disease is associated with an increased risk of the coronary disease and cerebrovascular disease. Intermittent claudication, the most common symptom of peripheral arterial disease, results from flow-reducing lesions in the arteries of the lower extremity that cause exercise-induced muscle ischemia. In order to evaluate intermittent claudication, many kinds of noninvasive diagnostic studies, including ABPI (ankle brachial pressure index) and the measurement of claudication distance, et al have been proposed. We have used the recovery time of the ischemic reaction at foot sole, plethysmography, thermography, laser doppler flowmetry, or NIRS (near-infrared spectroscopy) after walking test, rather than ABPI. These examinations will be superior to ABPI to evaluate effects after ergotherapy or pharmacotherapy for patients with intermittent claudication. Carotid artery sclerosis may be a good marker of systemic atherosclerosis. By our assessment of risk factors, the progression of atherosclerotic change in carotid artery was strongly correlated with two risk factors, such as smoking and systolic blood pressure. In the cholesterol analysis, Lp (a) was only high risk factor for atherosclerotic change of carotid artery. Recent technical advances, adequate evaluation of systemic atherosclerosis, and reduction of risk factors should improve the prognosis of patients with peripheral arterial disease.     

Prevalence of lower extremity arterial disease among elderly people in the community.

To estimate the prevalence of lower extremity arterial disease, all patients aged over 65 years registered with a rural general practice near Cambridge were invited to attend for examination of the circulation to the lower extremities; 265 subjects (80%) accepted. Three methods were used to investigate the presence of lower extremity arterial disease - enquiring about symptoms of intermittent claudication; clinical examination (and particularly the detection of arterial bruits); and pressure index calculations from measurements of the ankle and brachial systolic blood pressure using a Doppler ultrasound probe. When examining the legs, the presence of a bruit was taken as stronger evidence of disease than inability to palpate the pulses which may be difficult or impossible to detect for a number of reasons. Forty seven of the 264 patients examined (18%) showed evidence of lower extremity arterial disease. Seven patients showed unequivocal evidence of lower extremity arterial disease as demonstrated by all three criteria, 12 by two criteria and 28 patients on one criterion alone. While the pressure index followed a normal distribution curve, there was a tendency for it to decline with age. Other risk factors which showed a correlation with evidence of disease including current, but not previous, cigarette smoking, and a history of stroke. The significance of the findings is discussed in the context of some degree of arterial pathology in many British subjects in this age group.     

Peripheral arterial disease and its relationship to cardiovascular risk factors and coronary heart disease in newly diagnosed non-insulin-dependent diabetics

The prevalence of peripheral arterial disease and its relationship to cardiovascular risk factors was investigated in 133 patients aged 45-64 years with newly diagnosed non-insulin-dependent diabetes and in 144 randomly selected non-diabetic subjects of the same age. History of intermittent claudication, absent foot pulses, decreased ankle-arm blood pressure ratio (less than 0.9) and radiologically detectable arterial calcifications of the lower limbs were used as indicators of the presence of peripheral arterial disease. Peripheral arterial disease tended to be somewhat more common in men with newly diagnosed non-insulin-dependent diabetes than in non-diabetic men, whereas no difference was found in prevalence of peripheral arterial disease between diabetic and non-diabetic women. The association of various indicators of peripheral arterial disease with cardiovascular risk factors and coronary heart disease was low or absent.     

Illness behaviour and antibiotic prescription in patients with respiratory tract symptoms.

BACKGROUND: Although the vast majority of respiratory tract symptoms are self-limiting, many patients visit their GP for these symptoms and antibiotics are over-prescribed. AIM: To explore determinants of patients visiting GPs for recent cough, sore throat, or earache; for being prescribed antibiotics; and for patients' satisfaction with visiting the GP. Design of the study: Second Dutch National Survey of General Practice (DNSGP-2) with a health interview and an additional questionnaire. SETTING: A total of 7057 adult patients of 163 GPs in the Netherlands. METHOD: Characteristics of patients and GPs as well as morbidity data were derived from the DNSGP-2 and a health interview. Characteristics of the symptoms, GPs' management and patients' satisfaction were measured by an additional written questionnaire. Data were analysed by means of multivariate logistic regression. RESULTS: About 40% of the responders (n = 1083) reported cough, sore throat, or earache in the 2 weeks preceding the interview and, of them, 250 visited their GP. Of this latter group, 97 patients were prescribed antibiotics. Apart from non-medical reasons, relevant medical factors played an important role in deciding to visit the GP. Smokers and patients with cardiac disease or diabetes mellitus were not especially inclined to see their GP. Smoking behaviour, fever, and views on respiratory tract symptoms and antibiotics of patients and GPs were associated with being prescribed antibiotics. Patients' perception of having been carefully examined was associated with their satisfaction, while receiving antibiotics was not. CONCLUSION: GPs should inform patients with clear elevated risk when to visit their GP in cases of cough, sore throat, or earache. There is still a need for GPs and patients to be better informed about the limited significance of single inflammation signs (for example, fever and green phlegm) as an indication for antibiotics. Careful examination of the patient contributes to patient satisfaction.     

The prognosis of non-critical limb ischaemia: a systematic review of population-based evidence.

BACKGROUND: Peripheral arterial occlusive disease (PAOD) is the most common peripheral vascular disorder in the elderly. A clear picture of the disease's course, especially in patients with non-critical limb ischaemia (Fontaine stages I and II), is essential for the general practitioner, who plays a key role in the diagnosis and management of PAOD. AIM: To evaluate the population-based evidence on the course and prognosis of PAOD. METHODS: An exhaustive literature search yielded 16 population-based studies on the prognosis of PAOD. The methodological qualities of the studies were assessed according to eight criteria. RESULTS: Thirteen studies of high methodological quality show that data on the course, cardiovascular morbidity, and mortality of asymptomatic PAOD are scarce. Only a small group of asymptomatic patients seem to develop intermittent claudication symptoms. However, asymptomatic patients appear to have the same increased risk for cardiovascular morbidity and mortality when compared with claudicants. No data were available on prognostic factors for intermittent claudication and cardiovascular morbidity in asymptomatic patients. The course, cardiovascular morbidity, and mortality of symptomatic PAOD are better documented. A small group of claudicants experience symptom progression. Smoking, hypertension, increasing age, and diabetes are the most relevant risk factors for intermittent claudication. Claudicants are at a higher risk for developing other cardiovascular diseases, resulting in a significantly increased mortality mainly owing to coronary heart disease. Intermittent claudication and a low ankle-brachial pressure index are significant predictors of mortality. Men had intermittent claudication and symptom progression more often than women. Cardiovascular (co-)morbidity was common in both male and female PAOD patients, but male PAOD patients had a higher mortality compared with female PAOD patients. CONCLUSION: Given the current knowledge on the prognosis of PAOD in the general population, an important task for (secondary) prevention is reserved for the general practitioner. Further research is required to document the course and prognosis of asymptomatic PAOD patients.     

Diagnostic classification in patients with suspected deep venous thrombosis: physicians' judgement or a decision rule?

Background

Clinical decision rules can aid in referral decisions for ultrasonography in patients suspected of having deep venous thrombosis (DVT), but physicians are not always convinced of their usefulness and rely on their own judgement.

Aim

To compare the performance of a clinical decision rule with the probability of DVT presence as estimated by GPs.

Design of study

Cross-sectional survey.

Setting

Primary care practices in The Netherlands.

Method

GPs (n = 300) estimated the probability of the presence of DVT (range 0–100%) and calculated the score for the clinical decision rule in 1028 consecutive patients with suspected DVT. The clinical decision rule uses a threshold of three points and so, for the GP estimates, thresholds were introduced at 10% and 20%. If scores were below these estimates, it was not considered necessary to refer patients for further examination. Differences between the clinical decision rule and the GP estimates were calculated; this is discrimination (c-statistic) and classification of patients.

Results

Data of 1002 patients were eligible for analysis. DVT was observed in 136 (14%) patients. Both the clinical decision rule and GP estimates had good discriminative power (c-statistic of 0.80 and 0.82 respectively). Fewer patients were referred when using the clinical decision rule compared with a referral decision based on GP estimates: 51% versus 79% and 65% (thresholds at 10% and 20% respectively). Both strategies missed a similar and low proportion of patients who did have DVT (range 1.4–2.0%).

Conclusion

In patients suspected of DVT both GP estimates and a clinical decision rule can safely discriminate in patients with and without DVT. However, fewer patients are referred for ultrasonography when GPs rely on a clinical decision rule to guide their decision making.     

Targeted screening for peripheral arterial disease in general practice: a pilot study in a high risk group

BACKGROUND: Screening of high-risk groups for peripheral arterial disease has been advocated because the condition underdiagnosed and secondary prevention can reduce cardiovascular event rates. AIM: To establish the feasibility of screening for peripheral arterial disease in people aged 60 years or over with hypertension, and to estimate the potential to improve secondary preventive treatment. DESIGN OF STUDY: Pilot study and cross-sectional survey. SETTING: Large general practice in north-east Scotland. METHOD: People aged 60 years or over with hypertension but no cardiovascular disease or diabetes were identified from computer records and invited to a screening clinic. Data were collected on ankle brachial pressure index (ABPI), preventive treatment, and risk factors. RESULTS: Of 705 potentially eligible patients, 443 (63%) agreed to participate. Sixty-four were excluded and 364 of 379 patients (96%) attended screening. Thirty patients had peripheral arterial disease (ABPI of 0.9 or less), of whom 24 (7%; 95% confidence interval [CI] = 4 to 10%) were previously undiagnosed. Fifteen (50%) patients took antiplatelets, 13 (45%) had cholesterol <5 mmol/l, and 16 (53%) had blood pressure below 140/85 mmHg. Twenty-two (73%) patients were non-smokers, 14 (47%) had low-fat diets, two (7%) were physically active, and three (10%) ate recommended amounts of fruit and vegetables. CONCLUSIONS: It is feasible to screen for peripheral arterial disease in primary care, but its prevalence is lower than anticipated. There is room for improvement in secondary preventive treatment and lifestyle, so a structured programme could still have important benefits for survival.     

A prospective evaluation of sensitivity and specificity of the ankle/brachial index in the follow-up of superficial femoral artery occlusions treated by angioplasty

The aim of this study was to provide estimates of sensitivity and specificity of clinical history, pulses, and ankle/brachial index (ABI) in the follow-up of atherosclerotic occlusions of the superficial femoral artery treated by peripheral transluminal angioplasty (PTA). A total of 116 patients were followed prospectively for 1 year after angioplasty with follow-up visits immediately after angioplasty, and at 3, 6, and 12 months. All patients underwent digital subtraction angiography after 1 year or if they reported a deterioration of their symptoms. Reobstruction was defined as reocclusion or as restenosis exceeding 70%. Patency rates were calculated separately by clinical and ankle/ brachial criteria; sensitivity and specificity were derived using angiography as standard. The presence or absence of pulses distal to the treated vessel segment had a sensitivity of 78% and a specificity of 66% for a reocclusion or significant restenosis; subjective complaints evaluated by history had a sensitivity of 83% and a specificity of 51%. The sensitivity of the ABI was 72% and 66%, with a specificity of 82% and 100% for cutoff values of 0.10 and 0.15, respectively. One year after PTA the angiographic patency rate was 39 % ± 5 %; the patency rate based on ABI criteria 34% ± 5%. A deterioration in the ABI by 0.15 indicated with reasonable certainty a reocclusion or significant restenosis whereas the sensitivity of the ABI was poor in detecting significant restenosis after PTA of occlusions of the superficial femoral artery. When only clinical criteria were used, the true patency rate was significantly overestimated as more than half of all reobstructions remained asymptomatic.Abbreviations ABI ankle/brachial index - PAOD peripheral arterial occlusive disease - PTA peripheral transluminal angioplasty     

Changes in peripheral blood pressures after five years of follow-up in non-operated patients with intermittent claudication

Changes in the segmental blood pressures (BP) in the legs after five years of follow-up and factors related to the changes were studied in 93 non-operated non-diabetic patients with intermittent claudication. Independent variables affecting the ankle/arm BP index (ABI) in the more affected leg were the initial ABI, smoking, duration of claudication and location of the stenoses (whether single or multiple). ABI was stable in non-smokers but decreased in smokers. It also decreased in patients with multiple stenoses at the initial examination but not in those with single stenoses. The correlation between subjective changes in claudication and changes in the ankle BP was poor. In the less affected leg, ABI decreased both in smokers and non-smokers but stenoses in legs without signs of stenoses initially developed to a greater extent in smokers than in non-smokers. Smoking is an important risk factor for progression of the occlusive atherosclerotic disease in intermittent claudication. Patients with multiple stenoses seem to have a more progressive occlusive disease.     

Provision of information and advice in cardiovascular care: clinical performance of general practitioners

The aim of this study was to assess the provision of information and advice by general practitioners (GPs) with respect to patients with hypertension, hypercholesterolaemia, or cardiovascular disease. The study relied on the prospective recording of patient encounters by GPs. Performance indicators were selected from the Dutch national guidelines for general practice. The GPs (n=195) completed 5330 encounter forms. High levels of performance were found with regard to advice on smoking cessation and the provision of information (e.g. information about alarm symptoms or the aim of treatment). Low levels of performance were found with regard to advice on salt consumption, alcohol consumption, weight reduction and physical exercise for patients with hypertension. Discussion of compliance with the therapy in case of hypercholesterolaemia, advice on physical exercise in case of angina pectoris and advice on foot care in case of peripheral arterial disease also showed a substantial gap between recommended and actual care. Performance rates varied considerably across GPs. The patient and GP characteristics examined in this study contributed very little to the clinical performance.     

A new method for measuring oxidative stress in claudicants during strenuous exercise using free radical derivatives of antipyrine as indicators: a pilot study

Patients with intermittent claudication disease suffer from temporary lack of oxygen in the legs, caused by narrowing of arteries, resulting in ischemia and followed by reperfusion. The degree of oxidative stress present in 16 patients during strenuous exercise was determined using several indicators. Two derivatives of an exogenous marker, antipyrine (AP), (ie, p-hydroxyantipyrine, p-APOH, and o-hydroxyantipyrine, o-APOH), were assayed in plasma using HPLC-tandem-MS. Plasma malondialdehyde (assayed as thiobarbituric acid reactive species, TBARS) was also determined. The branchial/ankle blood pressure index (b-a index) was used to assess the severity of intermittent claudication disease, and plasma lactate concentration was also measured as an indicator of the ischemic situation. Plasma TBARS level did not change significantly after exercise. During the ischemic situation as well as during reperfusion, both free radical derivatives of antipyrine increased significantly in plasma (p < 0.01). Because p-APOH is also formed enzymatically in humans, the plasma ratio of o-APOH to AP appeared to be the most specific marker for oxidative stress in patients with intermittent claudication.     

Evaluation of general practitioners' training: how to manage patients with unexplained physical symptoms

Patients with unexplained physical symptoms ("somatoform disorders") tend to overuse the healthcare system. Therefore, the authors aimed to assess whether a training session for general practitioners (GPs) on managing patients with unexplained physical symptoms would be acceptable to GPs and lead to improvements in patient care. In a randomized clinical trial (GPs randomized), GPs got a 1-day training session and additional materials. Included were 26 GP offices in primary care and 295 patients with unexplained physical symptoms (minimum of two symptoms required). Outcome measures were healthcare utilization (number of doctor visits) 6 months before and 6 months after the index visit to the GP, somatization severity, depression, and hypochondriacal fears at the index visit to the GP's office and 6 months later. Training GPs to manage these patients led to significant reductions in healthcare utilization; patients of untrained GPs showed comparable attendance rates in the 6 months before and after the index visit. Differences in depression, somatization, and hypochondriacal fears, however, could not be attributed to the GP training. GPs rated the training as being highly relevant for their everyday practices, underlining the need for and acceptance of the training. Training GPs in managing patients with unexplained physical symptoms seems to be helpful for the reduction of excessive healthcare utilization. These 1-day workshops have high acceptability, so this approach could be a good model for empirically-validated continuing-education programs.     

Diabetes mellitus and intermittent claudication. Relation between peripheral vascular complications and location of the occlusive atherosclerosis in the legs

Forty-seven diabetic patients with intermittent claudication without rest pain or gangrene at the initial examination were followed up over a six-year period. They were compared with 224 non-diabetic patients with intermittent claudication. The cumulative proportions of patients with gangrene were 31% in the diabetic group and 5% in the control group (p less than 0.001). The corresponding figures for rest pain and/or gangrene were 40 and 18%, respectively (p less than 0.001). The frequency of aorto-iliac and multiple stenoses was higher among diabetic patients who developed peripheral vascular complications (rest pain, gangrene) than in the control group. The frequency of multiple stenoses was also higher in the former subgroup than in diabetics without such complications. In conclusion, the degree of involvement of the large vessels in occlusive arterial disease influences the risk of development of peripheral vascular complications in diabetic patients with intermittent claudication.     

Ankle brachial index measurement in primary care: are we doing it right?

Background

The reference standard for diagnosing peripheral arterial disease in primary care is the ankle brachial index (ABI). Various methods to measure ankle and brachial blood pressures and to calculate the index are described.

Aim

To compare the ABI measurements performed in primary care with those performed in the vascular laboratory. Furthermore, an inventory was made of methods used to determine the ABI in primary care.

Design of study

Cross-sectional study.

Setting

Primary care practice and outpatient clinic.

Method

Consecutive patients suspected of peripheral arterial disease based on ABI assessment in primary care practices were included. The ABI measurements were repeated in the vascular laboratory. Referring GPs were interviewed about method of measurement and calculation of the index. From each patient the leg with the lower ABI was used for analysis.

Results

Ninety-nine patients of 45 primary care practices with a mean ABI of 0.80 (standard deviation [SD] = 0.27) were included. The mean ABI as measured in the vascular laboratory was 0.82 (SD = 0.26). A Bland–Altman plot demonstrated great variability between ABI measurements in primary care practice and the vascular laboratory. Both method of blood pressure measurements and method of calculating the ABI differed greatly between primary care practices.

Conclusion

This study demonstrates that the ABI is often not correctly determined in primary care practice. This phenomenon seems to be due to inaccurate methods for both blood pressure measurements and calculation of the index. A guideline for determining the ABI with a hand-held Doppler, and a training programme seem necessary.     

Characteristics of children consulting for cough, sore throat, or earache.

BACKGROUND: GPs are often consulted for respiratory tract symptoms in children. AIM: To explore characteristics of children, their parents, and their GPs that are correlated with consulting a GP for cough, sore throat, or earache. DESIGN OF STUDY: Second Dutch National Survey of General Practice (DNSGP-2) with a health interview and an additional questionnaire. SETTING: Children aged 0-17 years registered with 122 GPs in Dutch general practice. METHOD: Characteristics of patients and their GPs were derived from the DNSGP-2 health interview and a questionnaire, respectively. Characteristics of the illness symptoms and GP consultation were acquired by means of an additional questionnaire. Data were analysed using multivariate logistic regression. RESULTS: Of all children who completed the questionnaire, 550 reported cough, sore throat, or earache in the 2 weeks preceding the interview with 147 of them consulting their GP. Young children more frequently consulted the GP for respiratory symptoms, as did children with fever, longer duration of symptoms, those reporting their health to be 'poor to good', and living in an urban area. When parents were worried, and when a child or their parents were cued by someone else, the GP was also consulted more often. GP-related determinants were not associated with GP consultation by children. CONCLUSION: This study emphasises the importance of establishing the reasons behind children with respiratory tract symptoms consulting their GP. When GPs are aware of possible determinants of the decision to consult a GP, more appropriate advice and reassurance can be given regarding these respiratory symptoms, which are generally self-limiting.     

Sex and attitude: a randomized vignette study of the management of depression by general practitioners.

BACKGROUND: The management and detection of depression varies widely, and the causes of variation are incompletely understood. AIMS: To describe and explain general practitioners' (GPs') current practice in the recognition and management of depression in young adults, their attitudes towards depression, and to investigate associations of GP characteristics and patient sex with management. METHOD: All GP principals in the Greater Glasgow Health Board were randomized to receive questionnaires with vignettes describing increasingly severe symptoms of depression in either male or female patients, and asked to indicate which clinical options they would be likely to take. The Depression Attitude Questionnaire was used to elicit GP attitudes. RESULTS: As the severity of vignette symptoms increased, GPs responded by changing their prescribing and referral patterns. For the most severe vignette, the majority of GPs would prescribe drugs (76.4%) and refer the patient for further help (73.7%). Male and female patients were treated differently: GPs were less likely to ask female patients than male patients to attend a follow-up consultation (odds ratio [OR] = 0.55), and female GPs were less likely to refer female patients (OR = 0.33). GPs with a pessimistic view of depression, measured using the 'inevitable course of depression' attitude scale, were less willing to be actively involved in its treatment, being less likely to discuss a non-physical cause of symptoms (OR = 0.77) or to explore social factors in moderately severe cases (OR = 0.68). CONCLUSIONS: Accepting the limitations of the method, GPs appear to respond appropriately to increasingly severe symptoms of depression, although variation in management exists. Educational programmes should be developed with the aim of enhancing GP attitudes towards depression, and the effects on detection and management of depression should be rigorously evaluated.     

Heterozygosity for homocystinuria in premature peripheral and cerebral occlusive arterial disease

Premature arteriosclerosis and thromboembolic events are well-known complications of homozygous homocystinuria due to cystathionine synthase deficiency. It is unknown whether heterozygosity for homocystinuria predisposes to premature vascular disease. We explored the frequency of excessive homocysteine accumulation after standardized methionine loading in 75 patients presenting with clinical signs of ischemic disease before the age of 50:25 with occlusive peripheral arterial disease, 25 with occlusive cerebrovascular disease, and 25 with myocardial infarction. In seven patients in each of the first two groups but in none of the patients in the third group, heterozygosity for homocystinuria was established on the basis of pathological homocysteinemia after methionine loading and cystathionine synthase deficiency in skin fibroblast cultures. Because the frequency of heterozygosity for homocystinuria in the normal population is 1 in 70 at the most, we conclude that this condition predisposes to the development of premature occlusive arterial disease, causing intermittent claudication, renovascular hypertension, and ischemic cerebrovascular disease.     

Potential of Phosphorus Nuclear Magnetic Resonance Spectroscopy in Studies of the Energy Metabolism of Skeletal Muscles

The aim of the present study was to investigate the possibility of phosphorus magnetic resonance spectroscopy (MR spectroscopy) in the diagnosis of metabolic lesions of skeletal musculature in patients with intermittent claudication syndrome, chronic cardiac failure, and varicose diseases of the lower limbs. Studies included 50 males: 20 patients with intermittent claudication, 10 patients with chronic cardiac failure, and 10 patients with varicose veins. The control group consisted of 10 healthy volunteers. The following measures were determined: the phosphocreatinine index, the intracellular pH in the gastrocnemius muscle, and the half-recovery time for the phosphocreatinine index. The phosphocreatinine index and the pH at rest did not differ between study groups. Isotonic exercise produced no change in the phosphocreatinine index in the control group; patients with intermittent claudication showed a 26.1% decrease, patients with chronic cardiac failure showed an 8% decrease, and patients with varicose veins showed a 25.6% decrease. The only group showing a significant decrease in pH during exercise was the group of patients with intermittent claudication. This group also showed an inverse correlation between the pressure index and the extent of the decrease in the phosphocreatinine index. Thus, MR spectroscopy provides a non-invasive diagnostic method for lesions of energy metabolism in skeletal musculature in patients with deranged peripheral hemodynamics.     

Effects of vacusac in intermittent claudication: a controlled cross-over study

The effect of a new physical treatment modality, Vacusac, was tested on a group of patients with stable intermittent claudication. Twenty-two patients with a median age of 65 years and a median duration of intermittent claudication of 5 years were randomized to either active or placebo treatments. Seventeen patients completed the study. The effect of treatment was quantified by measurements of systemic and peripheral systolic blood pressures and by measurements of the pain-free and the maximal walking distance on a treadmill. The ankle pressure index (ankle systolic pressure/arm systolic pressure) and toe pressure index (toe systolic pressure/arm systolic pressure) were calculated. After 25 active treatments, administered over a period of 2 months, the patients allocated to this group attained a significant increase in the pain-free walking distance from 54 m (24-107 m) to 99 m (30-420 m) (P less than 0.05) and in the maximal walking distance from 99 m (36-182 m) to 185 m (68-591 m) (P less than 0.05). The patient group receiving 25 placebo treatments did not show any significant changes in either the pain-free or the maximal walking distance. This group then received 25 active treatments over a period of 2 months. This active treatment resulted in a significant increase in the pain-free walking distance from 51 m (14-100 m) to 86 m (18-1000 m) (P less than 0.05) and in the maximal walking distance from 98 m (40-199 m) to 175 m (51-1000 m) (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)