Consideration for intermittent claudication in the calf in view of hemodynamics of leg muscles

Abstract

In 45 limbs with occlusion only in the leg arteries with Buerger's disease relationship between the anatomical levels of arterial occlusion and muscle insufficiency in the anterior tibial, gastrocnemius and soleus muscles evaluated by Xe-133 clearance method was examined. Furthermore, pathogenesis of intermittent claudication in the calf was reconsidered from these results compared with clearance curves attained from 46 limbs of 39 patients with occlusion or stensis proximal to the popliteal artery.All four cases with complete occlusion of the anterior tibial artery and one case with severe stenosis in 1.5cm length at its origin had abnormal clearance curves in the anterior tibial muscle. In the other cases the frequency of development of muscle insufficiency did not correlate with the anatomical levels of occlusion.Curves from cases with occlusion or stenosis of the anterior tibial artery at its origin showed similar striking abnormality in the anterior tibial muscle as those with severe intermittent claudication. However, even though these severe insufficiency in the anterior tibial muscle was shown, patients did not complain of intermittent claudication in the leg. This may be explained that volume of the anterior tibial compartment is less than that of the posterior tibial compartment and work load performed by the anterior tibial muscle during walking is less than that by the calf muscles. Therefore, it could be considered that circulatory insufficiency in the anterior tibial muscle does not develop intermittent claudication in the leg during ordinary walking. The other abnormal curves obtained from the cases with occlusion distal to the origin or open of the anterior tibial artery showed significantly slight abnormality.Circulatory insufficiency of the gastrocnemius muscle was produced by occlusions not only of the sural artery, but also of the posterior tibial artery at its origin or at the origin of the peroneal artery, indicating vascular tracts existed from the posterior tibial artery to the gastrocnemius muscle. In cases without occlusion or stenosis proximal to the popliteal artery, the sural artery, the posterior tibial artery and the muscle nutritive arteries were concerned with development of intermittent claudication in the calf each other.One case whose Xe-133 clearance curves indicated that intermittent claudication developed owing to the circulatory insufficiency of the soleus muscle was reported.