Venous claudication. A report of 15 cases and a review of the literature

The symptom of intermittent claudication is not invariably due to arterial disease. Exercise-related pain resulting from venous insufficiency is poorly defined, but has been described by a number of authors in the past. Fifteen patients with symptoms suggestive of venous claudication are reported. The history and clinical findings are described. The further investigation of these patients is outlined, starting with the non-invasive methods of Doppler ultrasonography and strain gauge plethysmography. Ascending phlebography was performed on all affected limbs (n. 19) and descending phlebography was performed on those shown to have a patent deep venous system. These investigations demonstrated deep venous abnormalities associated with the distinct symptom complex. Venous claudication is defined and the literature reviewed. It is hoped that a clearer understanding of the condition will result in more frequent and accurate diagnosis with subsequent benefit to the patient.     

Fate of the patient with chronic leg ischaemia. A review article

Much has been published on the surgical treatment of leg ischaemia but relatively little is known about the incidence of claudication and the fate of the majority of patients presenting with chronic leg ischaemia who never come to surgery. A review of the available literature suggests the following conclusions: (1) about 1.5% of men under 49 and 5% of men over 50 will develop symptoms of intermittent claudication. The incidence of asymptomatic arterial disease is much higher; (2) the incidence of claudication in women is only slightly less, but the local disease follows a more benign course; (3) compared to the general population of comparable age the mortality of men presenting with chronic leg ischaemia is two to three times higher after 5 years; (4) about 50% of deaths will be due to myocardial ischaemia, 15% to stroke and 10% to vascular disease in the abdomen. In only 25% will the principal cause of death be unconnected with the circulation; (5) there is virtually no reliable information available at the moment on the incidence of non-fatal myocardial infarction or stroke in these patients.     

Coagulation tests on capillary blood: A screening procedure for use in small children

A method of investigating the coagulation mechanism is described.     

Serial plasmapheresis in a haemophiliac with antibodies to FVIII.

Serial plasmaphereses were performed on a 23-year-old haemophiliac, with antibodies to factor VIII (FVIII), in order to reduce the antibody level before multiple dental extractions. Eight phereses were carried out in which approximately 1.5 litres plasma was exchanged with isotonic saline. By the ninth exchange, which was carried out immediately before the extraction, the antibody level had fallen from 4 u/ml to 0.8 u/ml. On this occasion fresh frozen plasma and FVIII concentrate were infused immediately after the pheresis. A normal post-infusion level of FVIII was achieved with a normal half disappearance time of the infused FVIII.     

Parenteral therapy with lipo-ecraprost, a lipid-based formulation of a PGE1 analog, does not alter six-month outcomes in patients with critical leg ischemia

PURPOSE: Eicosanoids with vasodilating and angiogenic properties have been postulated to be effective therapies for critical leg ischemia (CLI) secondary to atherosclerotic peripheral arterial disease. The ability to deliver active drug to the site of action at adequate doses for sufficient duration has been a major limitation in the clinical development of such therapies. Lipo-ecraprost is a lipid-encapsulated prostaglandin E1 prodrug with the potential to deliver active prostaglandin to the site of critical arterial ischemia. The current trial was designed to test the hypothesis that lipo-ecraprost would improve amputation-free survival in patients with CLI who had no revascularization options. METHODS: The study was randomized, multicenter, double blind, and placebo controlled. Patients who met clinical and hemodynamic criteria were randomized to receive placebo or lipo-ecraprost (60 microg) administered intravenously on each of 5 days per week, for a total of 8 weeks. The study's primary endpoint was the rate of a composite end point of death or amputation above the level of the ankle at 180 days (6 months). RESULTS: The study was terminated on a recommendation from the Data and Safety Monitoring Board after the completion of a protocol-specified interim analysis for futility. At the time of termination, 383 of the planned 560 patients had been randomized, of which 379 received at least one dose of study medication and thus were included in the intention-to-treat population. Twenty-three patients were lost to follow-up and were not available for 6-month assessments. At 6 months of follow-up, there were 23 amputations in the 177 patients who received placebo, and 29 amputations in the 179 patients randomized to lipo-ecraprost. At 6 months, 10 deaths had occurred in the placebo group and 18 deaths had occurred in the lipo-ecraprost arm. Changes in lower-extremity hemodynamics over the 6-month study period did not differ between the placebo and lipo-ecraprost treatment arms. CONCLUSION: Intensive treatment with lipo-ecraprost failed to modify the 6-month amputation rate in patients with CLI who were not candidates for revascularization.