The effect of supplemental oxygen on the transarterial wall oxygen gradients at a prosthetic vascular graft to artery anastomosis in the rabbit.

Artery wall hypoxia has been proposed to contribute to many kinds of artery wall pathology, including atherosclerosis and intimal hyperplasia. The purpose of this study was to determine the effect of supplemental oxygen on the transarterial wall oxygen gradients at a prosthetic vascular device (PVG)-to-artery anastomosis. The transarterial wall oxygen gradient in the infrarenal aorta of New Zealand White rabbits housed for 42 days in a 40% supplemental oxygen was measured with an oxygen microelectrode 2 mm distal to a PVG-to-artery anastomosis. Oxygen tensions were significantly increased throughout the artery wall at all time points in the supplemental oxygen groups compared to those in non-oxygen-supplemented groups. Within the oxygen-supplemented groups, the outer artery wall had diminished oxygen tensions immediately following creation of the anastomosis, with a slow return to control oxygen tensions on postanastomosis day 42 which correlated with a return of the vasa vasorum. These changes were noted without differences in blood pressure or arterial blood oxygen concentrations within the oxygen-supplemented group. Artery wall hypoxia noted following the creation of a PVG-to-artery anastomosis can be eliminated and artery wall oxygen tensions significantly increased by the administration of supplemental oxygen.

Supplemental oxygen controls cellular proliferation and anastomotic intimal hyperplasia at a vascular graft-to-artery anastomosis in the rabbit.

PURPOSE: The purpose of this study was to determine whether the administration of 40% supplemental oxygen (O ( 2) ) will decrease cellular proliferation and intimal hyperplasia (IH) at a prosthetic vascular graft (PVG)-to-artery anastomosis. METHODS: Twenty New Zealand white rabbits underwent placement of a 3-mm polytetrafluoroethylene graft in their infrarenal aorta. Four groups of five rabbits were placed either in a normoxic (21%) environment or in a 40% supplemental O ( 2) environment for 7 or 42 days. Twenty-four hours before the rabbits were humanely killed for aortic graft harvest, BrDU (5-bromo-2'-deoxyuridine) was injected into the rabbits intraperitoneally. Image analysis (Bioquant) morphometrics were used to measure cells with BrDU staining and intimal areas at the distal anastomosis. Cellular proliferation is defined as positively staining BrDU cells divided by all cells in the artery wall. IH is reported as a ratio between the intimal area and the medial area to standardize the varying aortic size and degree of aortic fixation among rabbits. The Student t test was used to compare cellular proliferation and IH between control and O ( 2) -treated rabbits. RESULTS: Cellular proliferation in the intima at 7 days was significantly reduced in the O ( 2) -treated animals (1.7% +/- 1%) versus the control animals (28.6% +/- 3%) ( P =.0001). The cellular proliferation in the intima at 42 days returned to preoperative levels in the O ( 2) -treated group (0.15%) and in the control group (0.11%) ( P = not significant). IH at 7 days was minimal, and no difference between the O ( 2) -treated group (0.017 +/-.006) and the control group (0.009 +/-.03) ( P = not significant) was found. IH was significantly reduced at 42 days in the O ( 2) -treated animals (0.031 +/-.012) when compared with the control animals (0.193 +/-.043) ( P =.006). CONCLUSIONS: Supplemental O ( 2) (40%) significantly reduces cellular proliferation and IH at the distal anastomosis of a PVG-to-artery anastomosis in the rabbit model.

Revascularization and quality of life for patients with limb-threatening ischemia.

Traditional outcomes following revascularization for chronic critical limb ischemia consider limb retention and hemodynamic results. Health-related quality of life is not measured. This study was undertaken to determine if surgery for chronic critical limb ischemia improves health-related quality of life. Forty-six patients undergoing revascularization (anklebrachial index <0.4 for nondiabetics, ankle-brachial index <0.6 for diabetics and rest pain or nonhealing ischemic ulcers) completed pre- and postoperative Short-Form 36 questionnaires, which were used to assess health-related quality of life in patients undergoing arterial reconstruction for chronic critical limb ischemia. Patients reported a mild improvement in functional status postoperatively, and overall low health-related quality of life. Health-related quality of life is slow to show progress following revascularization. Health-related quality of life should become an important outcomes end point.

Transarterial wall oxygen gradients at the deployment site of an intra-arterial stent in the rabbit.

Intimal hyperplasia, common at the deployment site of an intra-arterial stent, may be caused by artery wall hypoxia. The purpose of this study was to determine the effect of an intra-arterial stent on artery wall oxygen concentrations. Transarterial wall oxygen gradients were measured by microelectrode at stent deployment sites in New Zealand White rabbits. Thinned artery walls and decreased oxygen tensions were noted throughout the artery wall immediately following stent deployment with a return toward control values at 28 days. Angioplasty alone had no acute effect on artery wall oxygen concentrations. Larger stent deployment diameters yielded acutely lower artery wall oxygen tensions. Using a linear one-dimensional model for the oxygen profile, we noted that stent deployment resulted in acute changes in oxygen consumption in the inner artery wall that rapidly returned to control values. Changes were noted without differences in blood pressure or arterial blood oxygen concentrations. Oxygen delivery to and consumption within the artery wall are altered by intra-arterial stent deployment. A role for artery wall hypoxia in artery wall pathology at the deployment site of an intra-arterial stent is supported by these findings.

Transarterial wall oxygen gradients at a prosthetic vascular graft to artery anastomosis in the rabbit.

PURPOSE: Artery-wall hypoxia has been proposed to contribute to many kinds of artery-wall pathologic conditions, including atherosclerosis and intimal hyperplasia. Intimal hyperplasia is common at sites of arterial injury, including an anastomosis. The purpose of this study was to determine the effect of a prosthetic vascular graft (PVG)-to-artery anastomosis on the delivery of oxygen to the artery wall. METHODS: The transarterial wall oxygen gradient in the infrarenal aorta of New Zealand White rabbits 2 mm distal to a PVG-to-artery anastomosis was measured with an oxygen microelectrode. RESULTS: Oxygen tensions were significantly decreased in the outer artery wall immediately after the creation of the anastomosis and showed a further decrease in oxygen tensions at days 7 and 14, which correlated with the absence of a vasa vasorum. After day 14, the oxygen tensions gradually increased, returning to normal by postanastomosis day 42, correlating with a return of the vasa vasorum. These changes were noted without differences in blood pressure or arterial blood oxygen concentrations. CONCLUSION: The delivery of oxygen to the artery wall is altered by the creation of a PVG-to-artery anastomosis. Low arterial oxygen tensions at a PVG-to-artery anastomosis support a role for artery-wall hypoxia in the formation of intimal hyperplasia at the site of a PVG-to-artery anastomosis.

Association of artery wall hypoxia and cellular proliferation at a vascular anastomosis.

BACKGROUND: We hypothesize that arterial wall hypoxia incites the pathologic formation of intimal hyperplasia at an artery anastomosis. We have determined from previous studies performed in our laboratory, the oxygen tension profiles of the artery wall at various times after vascular anastomosis. The purpose of this study is to determine the rate of cellular proliferation at an artery anastomosis when the artery wall is most hypoxic. MATERIALS AND METHODS: Expanded polytetrafluoroethylene (ePTFE) grafts were placed end to end in the infrarenal aorta of 27 New Zealand white rabbits. The anastomotic aortic wall oxygen (O(2)) tensions were measured with an O(2) microelectrode in rabbits 0, 7, 14, 28, and 42 days after surgery. O(2) tensions were also measured in 4 control rabbits for comparison. 5-Bromo-2'-deoxyuridine (BrDU) was injected intraperitoneally 24 h prior to rabbit sacrifice. After O(2) tension measurements, the rabbits were sacrificed and the aortic grafts were harvested. Bioquant morphometrics was used to measure cells with BrDU counterstaining and intimal thickness in 17 rabbits: in control (n = 4), Day 0 (n = 4), 7 (n = 5), and 42 (n = 4). Student's t test was used to compare O(2) tensions, cellular proliferation, and intimal hyperplasia between days. RESULTS: The pO(2) levels at the outer layers of the aorta, 1 mm distal to the distal aortic graft anastomosis, were 61.0 +/- 2 (+/-SE) mm Hg for controls, 19.8 +/- 1 mm Hg for Day 7 (P < 0.0001), 19.0 +/- 1 mm Hg for Day 14, 39.2 +/- 1 mm Hg for Day 28, and 58.5 +/- 1 mm Hg for Day 42 aortic grafts. BrDU-staining ratios in the intima were significantly higher in the Day 7 aortic grafts, 28.6 +/- 3%, versus BrDU-staining ratio, 1.4 +/- 1%, in Day 42 aortic grafts (P < 0.0002). CONCLUSIONS: Cellular proliferation is highest at Day 7 when the artery wall is most hypoxic and returns to baseline as O(2) tensions normalize.

Comparing patency rates between external iliac and common iliac artery stents.

PURPOSE: Placement of intraluminal stents in the common iliac artery (CIA) and external iliac artery (EIA) has become an accepted therapy for treating localized arterial stenoses. The purpose of this study was to compare anatomic patency rates of stents placed in the EIA and CIA for occlusive disease. METHODS: A radiologic computer database was used to identify 69 consecutive male patients at the Minneapolis Veterans Affairs Medical Center from February 1, 1993, through January 31, 1999, who underwent placement of 98 stents (82 Wallstents and 16 Palmaz stents) for physiologically significant iliac artery occlusive disease and varying degrees of chronic limb ischemia. Patients were followed up with surveillance duplex ultrasound scanning examinations 1 day after procedure, 3 months after procedure, and then at 6-month intervals after stent placement. Follow-up angiograms were performed for patients with duplex ultrasound scans that revealed velocities greater than 300 cm/s. Patient risk factors, iliac artery runoff, concomitant outflow procedures, and anatomic patency rates were compared between patients receiving EIA stents and those receiving CIA stents. RESULTS: The mean age for the EIA stent group was 69 +/- 1 years versus 66 +/- 1 years (P =.03) for the CIA stent group. Mean follow-up was 21.4 +/- 2.1 months (+/- SE) for all patients. Patients with EIA stents had more ischemic lower limbs when compared with patients who had CIA stents (P =.05). No differences were found between groups in risk factor analysis (P = not significant). Lesion lengths were similar between groups: EIA, 4.6 +/- 0.6 cm, and CIA, 5. 3 +/- 0.8 cm (P = not significant). The following differences were noted on primary patency rates (EIA group vs CIA group): 1 year (93% vs 88%), 2 years (91% vs 85%), and 3 years (90% vs 78%) (Cox proportional hazards; P =.13). CONCLUSIONS: Anatomic patency rates for EIA and CIA stents appear to be similar despite the fact that patients with EIA stents were older and had more ischemic limbs compared with the patients who had CIA stents.

Superficial femoral popliteal vein: An anatomic study.

OBJECTIVE: The superficial femoral popliteal vein (SFPV) has been used as an alternative conduit for both arterial and venous reconstructive surgery. Its popularity continues to grow, despite concern about the potential for venous morbidity after harvest. The purpose of this study was to determine an anatomic "safe" length of SFPV for harvest, assuming that the preservation of at least one valve and one significant collateral vein in the remaining popliteal vein (PV) segment can minimize venous morbidity. METHODS: Forty-four SFPVs were harvested from 39 cadaveric specimens. The length of both the superficial femoral vein (SFV) and PV was measured, and the number and location of valves and significant side branches (more than 2 mm in diameter) of the PV were measured. The Student two-tailed t test was used as a means of comparing vein lengths between the sexes. Correlation coefficients were determined for the effect of patient height on vein length, stratified by means of sex. RESULTS: Vein length (SFV mean, 24.4 +/- 4 cm; PV mean, 18.8 +/- 4 cm) varied with sex (male SFV mean, 28.1 +/- 5 cm; male PV mean, 21. 5 +/- 3 cm; female SFV mean, 22.6 +/- 4 cm; female PV mean, 18.4 +/- 3 cm; P =.01). Valve number (mean, 1.8 +/- 0.5) and location and collateral vein number (mean, 5 +/- 1.8) and location were variable and independent of height or sex. CONCLUSION: An anatomic "safe" length of SFPV for harvest to minimize venous morbidity would include all the SFV and 12 cm of PV in 95% of women and 15 cm of PV in 95% of men. We found that the male sex was a significant determinant for a longer safe length of vein that can be harvested.

Expansion rates and outcomes for iliac artery aneurysms.

PURPOSE: The expansion rates and outcomes of iliac artery aneurysms (IAAs) were determined. METHODS: A retrospective chart review was conducted to identify patients in whom IAAs had been diagnosed between June 1990 and March 1999 in a vascular surgery service at a large university-affiliated Veterans Affairs medical center. The patients were veterans, 187 men and two women, in whom the diagnosis of an IAA was made, as defined by the Ad Hoc Committee on Reporting Standards of The Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter (IAA >/= 1.5 cm). Expansion rates relative to the size of IAAs and clinical outcomes were noted for all patients. RESULTS: One hundred eighty-nine patients (mean age, 72.3 +/- 0.5 years) with 323 IAAs (mean size, 2.34 +/- 0.7 cm) were found. The mean follow-up (96% of patients with B mode ultrasound scanning) period was 31.4 months, with each patient undergoing a mean of 4.2 studies. The 4-year life-table survival rate was 78.2%, with no patient deaths related to their IAAs. Symptoms were noted in six of 189 patients (3.1%; two ruptures, four chronic pain), who all had IAAs larger than 4 cm. IAAs were repaired in 34 of 189 patients (18%), in 25 of the 34 patients because of their associated abdominal aortic aneurysms and in nine of 34 patients because of their IAAs alone. All nine patients requiring operative treatment of indications related to the IAA had an IAA larger than 4 cm. Expansion rates were slow for IAAs smaller than 3 cm (0.11 +/- 0.02 cm/year) and significantly greater (P <.003) for IAAs 3 to 5 cm (0.26 +/- 0.1 cm/year). The correlation between B mode ultrasound scanning and computed tomography scanning was excellent. The size of the IAAs was underestimated by 0.03 +/- 0. 06 cm by means of B mode ultrasound scanning. CONCLUSION: The IAAs followed up by this contemporary Veterans Affairs vascular surgery service were small, rarely caused symptoms or rupture, and expanded at a slow rate. IAAs smaller than 3 cm could be followed up safely on an annual basis with B mode ultrasound scanning. IAAs that are 3 cm or larger and smaller than 3.5 cm should be carefully followed with B mode ultrasound scanning at 6-month intervals, whereas elective repair should be considered for IAAs 3.5 cm or larger in good-risk patients. Based on this report and currently available evidence and recommendations, asymptomatic IAAs that are 4 cm or larger and all other symptomatic IAAs should be considered for operative repair. Also, the reported high rupture rate of IAAs that are 5 cm or larger mandates prompt operative repair.

Incidence of erectile dysfunction after open abdominal aortic aneurysm repair.

The aim of this study is to document the incidence of erectile dysfunction (ED) following open abdominal aortic aneurysm (AAA) repair using a modified International Index of Erectile Function questionnaire (IIEF). An IIEF was mailed to 175 married male patients (mean age +/- SD: 71 +/- 8 years) who had an open AAA repair by one of four board-certified vascular surgeons between 1994 and 1998. The IIEFs were anonymous and asked patients to recall their sexual function before and 3 months after repair. ED was defined in patients with IIEF scores <11 (range 1-30). The overall response rate was 39% (68/175). A comparison of the IIEF results showed that 67/68 patients reported worsening erectile function (p < 0.00001); one respondent reported improved erectile function. On the basis of the IIEF scores, 20/68 patients (29%) were found to have ED and 48/68 patients (71%) had normal function prior to repair. Of the 48 patients with normal function prior to surgery, 83% (40/48) had ED after surgery. ED rates were similar between tube grafts 82% (23/28) and bifurcated grafts 85% (17/20) p = ns. The ED rate after open AAA repair is alarmingly high and prospective follow-up with IIEF will be necessary to better assess true ED rates after conventional open AAA repair.

Use of a noncontact radiant heat bandage and Staphylococcus aureus dermal infections in an ovine model.

Diabetic foot wounds are difficult to manage due to relative tissue ischemia and high rates of soft tissue infection. One potential treatment modality is the application of local radiant heat to promote wound healing and control infection. However, there are concerns that local heat will spread rather than control infection. We determined in this study the effect of a noncontact radiant heat bandage in controlling an ischemic soft tissue infection. Bilateral 10 x 15 cm dermal flaps were created in 15 adult range sheep. The flaps were inoculated intradermally with 107 Staphylococcus aureus in 3 separate areas. The control flap was left open to air, while the treatment flap was covered with a noncontact radiant heat bandage and heated to 38 degrees C for three 1-hour periods separated by two 1-hour nonheating periods daily. After 10 days, both dermal flaps were harvested and sent for quantitative bacteriology. Due to operative complications, 12 of 15 sheep completed the study. The heated flap temperature was significantly higher 39.2 +/- 0.5 degrees C (+/- SE) vs. the control flap 36.1 +/- 0.1 degrees C (p < 0.00001) and bacterial counts were significantly smaller in the heated flap (median 1.0 x 107 colony-forming units per gm tissue) when compared to the control flap (median 7.5 x 107) (p = 0.001). This study shows the use of a noncontact radiant heat bandage controls ischemic soft tissue infections in an ovine model.

Wound infection after infrainguinal bypass operations: multivariate analysis of putative risk factors.

Reported wound infection rates for infrainguinal bypass operations range from 17% to 44%, but there is limited appreciation of which characteristics of patients or operations are reliable markers of increased wound infection risk. The purpose of the present study was to analyze all wound infections observed after infrainguinal bypass operations during 20 years of practice in a large teaching institution. Independent risk factors for wound infection development were identified. During the 20-year period ending 31 December, 1997, 978 male patients underwent infrainguinal bypass operations at the Minneapolis Department of Veterans Affairs Medical Center. Wound infections complicated the recovery of 129 of these patients during a 30-day postoperative surveillance interval. Multivariate logistic regression analysis was used to test the association between wound infection occurrence and putative risk factors that were either features of patients or characteristics of the operations. The following variables were examined: obesity, prosthetic graft placement, diabetes mellitus, steroid use, anticoagulation use, length of preoperative hospital stay, development of incisional hematoma, duration of operation, and the preoperative presence of a non-healing wound in the extremity being revascularized. The overall wound infection rate was 13.2% (129/978). In a final logistic regression model, obesity was a significant and independent predictor of wound infection (Relative Risk 2.6, 95% confidence interval, 1.35-4.90), as was development of a post-operative incisional hematoma (Relative Risk 6.44, 95% confidence interval, 2.95-14.08). No other explanatory variable was significantly associated with wound infection development.

Use of a noncontact radiant heat bandage for the treatment of chronic venous stasis ulcers.

A noncontact radiant heat bandage was used for the treatment of chronic venous stasis ulcers (mean duration 4.44 years) in inpatients who had failed aggressive inpatient and outpatient conventional therapy. The noncontact radiant heat bandage was placed over the ulcer for 5 hours daily: three 1-hour heating periods separated by two 1-hour nonheating periods during this 2-week trial. Wound size, status, and pain severity were recorded for each patient. A total of 17 patients with 31 total wounds were enrolled. No adverse effects were noted in any patient. There was improvement in 14/17 total patients during the 2-week inpatient trial and 8/17 patients healed completely after discharge. There was 1 recurrence during an 18-month follow-up. Pain scores were improved in most patients after the bandage was applied. The use of a noncontact radiant heat bandage is a safe and efficacious inpatient therapy for the management of chronic venous stasis ulcers in patients who have failed conventional therapy.

Chronic critical limb ischemia: diagnosis, treatment and prognosis.

Chronic critical limb ischemia is manifested by pain at rest, nonhealing wounds and gangrene. Ischemic rest pain is typically described as a burning pain in the arch or distal foot that occurs while the patient is recumbent but is relieved when the patient returns to a position in which the feet are dependent. Objective hemodynamic parameters that support the diagnosis of critical limb ischemia include an ankle-brachial index of 0.4 or less, an ankle systolic pressure of 50 mm Hg or less, or a toe systolic pressure of 30 mm Hg or less. Intervention may include conservative therapy, revascularization or amputation. Progressive gangrene, rapidly enlarging wounds or continuous ischemic rest pain can signify a threat to the limb and suggest the need for revascularization in patients without prohibitive operative risks. Bypass grafts are usually required because of the multilevel and distal nature of the arterial narrowing in critical limb ischemia. Patients with diabetes are more likely than other patients to have distal disease that is less amenable to bypass grafting. Compared with amputation, revascularization is more cost-effective and is associated with better perioperative morbidity and mortality. Limb preservation should be the goal in most patients with critical limb ischemia.

The effect of hypercholesterolemia on the rabbit transarterial wall oxygen gradient.

The objective of this study was to determine the effect of hypercholesterolemia on the transarterial wall oxygen gradient. Female New Zealand white rabbits (3-4 kg) were fed a 0.5% cholesterol supplemented diet or a 0.25% cholesterol supplemented diet and their transarterial wall oxygen gradients measured prior to the formation of atherosclerotic lesions at 4 weeks (0.5% cholesterol group) or 8 weeks (0.25% cholesterol diet) after beginning the diet. Arterial blood oxygen content and arterial blood pressure were recorded during the experiments. Control rabbits had a serum cholesterol level of 52.8 +/- 6 mg/dl, rabbits fed the 0.25% cholesterol diet had serum cholesterol levels of 579.5 +/- 29.2 mg/dl, and those fed the 0.5% cholesterol diet had serum cholesterol levels of 1235.4 +/- 37.6 mg/dl. There was no difference in the transarterial wall oxygen gradients between any of the groups. These results were noted with no differences in arterial blood oxygen content, arterial blood pressure, or evidence of atherosclerotic lesions. Hypercholesterolemia does not alter the delivery of oxygen to the artery wall prior to the formation of atherosclerotic lesions.

Warm-Up Active Wound Therapy: a novel approach to the management of chronic venous stasis ulcers.

This preliminary study investigates the use of a radiant-heat bandage, Warm-Up Active Wound Therapy, as a new approach to the treatment of patients with chronic venous ulcers. Thirteen patients were randomly assigned to either conventional therapy or Warm-Up Active Wound Therapy for inpatient treatment of chronic venous stasis ulcers. Our results indicated that Warm-Up Active Wound Therapy is more effective than conventional therapy in healing chronic venous ulcers, and patients reported a significant reduction in wound pain. Warm-Up Active Wound Therapy also was found to be a safe treatment modality with no adverse events occurring in any patient.

Cigarette smoking alters the rabbit transarterial wall oxygen gradient.

The objective of this study is to determine the effect of short-term (3 weeks) and long-term (10 weeks) cigarette smoking on the transarterial wall oxygen gradient. Female New Zealand White Rabbits (3-4 kg) were exposed to the smoke of seven nonfiltered cigarettes daily and their transarterial wall oxygen gradients measured at 3 weeks or 10 weeks before and during cigarette smoke exposure. Arterial blood oxygen content, percent of carboxyhemoglobin, and arterial blood pressure were recorded during the experiments. Short-term cigarette smoking resulted in a decrease in the artery wall oxygen content only during exposure to cigarette smoke that corresponded to arterial blood hypoxia. Long-term cigarette smoke exposure resulted in a sustained decrease in artery wall oxygen content noted 24 hours after last exposure to cigarette smoke with normal levels of arterial blood oxygen and an acute decrease during cigarette smoke exposure with corresponding arterial blood hypoxia. These results were noted despite no differences in blood pressure or evidence of atherosclerotic lesions. Short-term cigarette smoking results in artery wall hypoxia only during cigarette smoke exposure and arterial blood hypoxia while long-term cigarette smoking results in sustained artery wall hypoxia in the presence of normal arterial blood oxygen content.

Diagnosis and treatment of abdominal aortic aneurysms.

Abdominal aortic aneurysms occur in 5 to 7 percent of people over age 60 in the United States. An aneurysm is defined as a permanent localized dilatation of an artery, with an increase in diameter of greater than 1.5 times its normal diameter. Abdominal aortic aneurysms may be manifested by catastrophic rupture, signs of pressure on other viscera or an embolism originating in the aneurysmal wall, but most cases are asymptomatic. The diagnosis is often made by physical examination of the abdomen, which reveals a pulsatile mass left of the midline, between the xyphoid process and the umbilicus. The diagnosis may be confirmed by B-mode ultrasound. Ultrasound screening should be considered for individuals at risk for abdominal aortic aneurysms. This group includes individuals over age 60 who smoke, have hypertension or have vascular disease. Elective surgical intervention is indicated for most patients with abdominal aortic aneurysms greater than 5 cm in diameter to prevent rupture and death. Smaller abdominal aortic aneurysms should be monitored by regular ultrasound measurements. Screening and identification of abdominal aortic aneurysms by primary care physicians can have a significant impact on patient survival.

Claudication: diagnosis and treatment.

Claudication is exercise-induced lower extremity pain that is caused by ischemia and relieved by rest. This underreported condition affects at least 10 percent of persons over 70 years of age and 2 percent of those 37 to 69 years of age. Claudication is usually caused by atherosclerotic narrowing of the arteries that supply blood to the lower extremities. The diagnosis may be suspected based on the history and the physical examination, and it is confirmed by Doppler segmental pressures and an ankle/brachial index. Initial treatment includes vigorous risk factor modification and an exercise program. Further treatment includes pentoxifylline and, occasionally, endovascular or bypass procedures.