Free-living Physical Activity as a Novel Outcome Measure in Patients with Intermittent Claudication

ObjectiveTo develop a method of event-based analysis that quantifies the fragmented nature of walking bouts in individuals with intermittent claudication [IC] and compare outcomes with age and gender-matched healthy controls.DesignCross-sectional.MaterialsThe activPAL? physical activity monitor.Methods7-day physical activity patterns were compared between individuals with IC (n = 30) and controls matched for age and gender (n = 30). The ratio of the number of walking events to upright events was calculated to provide an event-based claudication index (EBCI) that represented the fragmented nature of walking bouts commonly reported in those with IC.ResultsIndividuals with IC had a greater EBCI than age matched controls indicating a more fragmented walking pattern (5.8 ± 2.0 vs. 7.7 ± 3.1, p < 0.01). The difference between groups was more pronounced when the EBCI was calculated from upright events that included >400 steps (23.4 ± 11.3 vs. 35.8 ± 14.2, p < 0.01).ConclusionThe classic fragmented stop/start walking pattern universally described by individuals with IC can be quantified using the EBCI. This method of measurement potentially provides a novel method of assessing the effectiveness of clinical interventions for this patient group.     

Arterial Reconstruction: Justified for Patients with Intermittent Claudication?

p < 0.0001). Arterial reconstruction for patients at Fontaine stage II offered benefits and improved quality of life at follow-up. Arterial reconstruction for patients at Fontaine stage II offers benefits and improved quality of life at follow-up. It was concluded that the significant improvement in quality of life after arterial reconstruction warrants continued use of the procedure in patients with intermittent claudication.     

Subintimal Angioplasty in the Treatment of Patients with Intermittent Claudication: Long Term Results

OBJECTIVES: Reporting the long-term results of subintimal angioplasty (SA) in patients with intermittent claudication (IC). DESIGN: A prospective study. PATIENTS: One hundred and sixteen SA procedures were performed in 104 patients, from February 1997 to January 2000. METHODS: This is a prospective study of patients treated for IC with infrainguinal SA. Primary assisted patency rates were calculated, also on intention to treat basis. Univariate and multivariate Cox regression tests were used to assess whether patency was correlated with co-morbidities, run-off or occlusion length. RESULTS: There was no early mortality. Technical success was achieved in 101 cases (87%). Primary assisted patency rates on intention to treat basis (116 cases) at 6, 12, 36 and 60 months were 69, 62, 57 and 54%, respectively. For successfully recanalized patients (101 cases) these respective numbers are 79, 70, 66 and 64%. Length of occlusion, age and male gender were independent risk factors for reocclusion. CONCLUSIONS: The satisfactory results obtained in the present study are probably due to two main factors. First, the three participating radiologist are highly skilled and experienced. Secondly, a conscientious surveillance was adhered to, so that restenoses could be diagnosed and treated early. SA is a relevant alternative to bypass surgery in patients with disabling IC due to long femoro-popliteal occlusions. It is far less traumatic than conventional vascular reconstructions, complications are few and not serious. Very importantly, SA never interfered with later successful vascular surgery. Therefore, we have adopted SA as the primary treatment for patients with IC when medical treatment alone has not been satisfactory.     

A New Device for the Measurement of Disease Severity in Patients with Intermittent Claudication

OBJECTIVES: To assess a new method of determining functional impairment in patients with intermittent claudication, the Double Physiological Walking Test (DPWT) using the PADHOC (Peripheral Arterial Disease Holter Control) device, against a standard treadmill test. DESIGN: Patients with intermittent claudication presenting to the department were considered for both the DPWT and a standard treadmill test. METHODS: initial claudicating distance, maximal walking distance and speed of walking were determined for both parts of the DPWT. Initial claudicating distance and maximal walking distance were determined from the treadmill test. Comparisons were made between the treadmill test and the DPWT. RESULTS: The treadmill test was unable to be performed in 22% of patients due to defined contraindications. There were strong correlations in both walking distances and disease severity when comparing the DPWT and the treadmill test. Patients in whom the treadmill test was contraindicated had significantly shorter walking distances on the DPWT than those who were able to complete a treadmill walking test. CONCLUSIONS: The DPWT correlates strongly with walking distances obtained from a standard treadmill test. However, the PADHOC can be used in a number of differing locations and settings as well as in patients in whom a treadmill test is contraindicated. It therefore has a role to play in the initial assessment of patients presenting with intermittent claudication.