Ankle Pressure Index Research Articles

Abstract P223: Vitamin D Supplementation Improves Measures Of Arterial Stiffness And Vascular Function In Adolescents Suffering From Orthostatic Intolerance

Background: In previous work we identified a group of adolescents with orthostatic intolerance (OI) presenting as postural orthostatic tachycardia syndrome or syncope with impairment in autonomic and vascular response upon head up tilt. Low vitamin D level correlated with the severity of symptoms. In this pilot study we hypothesized that vitamin D supplementation will improve the vascular function in these adolescents. Methods: A cohort of twenty Adolescents (mean age= 16.2 years, 4 males) who are vitamin D deficient had a non-invasive measurements of brachial BP, aortic BP, augmentation index at heart rate of 75 beats per minute (AIx75), and carotid-femoral pulse wave velocity (cf-PWV) using the SphygmoCor XCEL System at baseline and after two months of vitamin D supplementation (2000-5000 IU daily based on baseline level). Both right and left side ankle pressure and ankle brachial index (ABI) were assessed using COLIN VP-1000 vascular profiling system. Impedance Cardiography (ICG) was used to estimate total arterial compliance (TAC) and thoracic fluid content (TFC) in supine position at rest and after hand grip challenge. Results: As shown in the table. Compared to baseline, vitamin D supplementation increased vitamin D level, increased TAC and TFC at baseline and under stress challenge. It also tended to reduced AIx75 and cf-PWV and reduced both right and left ankle pressure and ABI Conclusions: Vitamin D supplementation improved different measures of vascular function in adolescent. These data provides evidence of potential therapeutic benefit of vitamin D supplementation for patients suffering from orthostatic intolerance who are vitamin D deficient.

Comparison of different exercise ankle pressure indices in the diagnosis of peripheral artery disease.

Although the resting ankle-brachial index (ABI) is commonly used as a tool to diagnose peripheral artery disease (PAD), several additional indices measured after exercise may have increased sensitivity for identifying PAD. The aim of this study was to determine the utility of resting ABI and three post-exercise physiological parameters for diagnosing PAD confirmed by arterial imaging studies. For each qualifying study, we assessed the performance measures for identifying PAD for resting ABI < 0.90, exercise ABI < 0.90, a decrease in ABI > 20% with exercise, and a decrease in ankle pressure > 30 mmHg with exercise. Of the 199 exams that met our inclusion criteria, imaging showed a > 75% stenotic lesion in at least one limb in 138 (69%) of patients. For stenoses > 75%, resting ABI < 0.90 had a sensitivity of 64% (95% CI: 56-72%) and exercise ABI < 0.90 had a sensitivity of 88% (95% CI: 82-93%). The sensitivity for a post-exercise ABI decrease > 20% was 67% (95% CI: 59-75%) and the sensitivity for a decrease in ankle pressure > 30 mmHg was 4% (95% CI: 2-9%). For individuals with a normal resting ABI but stenotic lesions > 75% confirmed by imaging (n=49), the addition of exercise ABI testing correctly identified an additional 25% of this population. Overall, exercise ABI < 0.90 exhibits a greater sensitivity for detecting PAD compared to resting ABI. Furthermore, exercise ABI < 0.90 had added clinical utility in patients with normal resting ABIs and was superior to other commonly used exercise indices.

Toe Pressure and Toe Brachial Index are Predictive of Cardiovascular Mortality, Overall Mortality, and Amputation Free Survival in Patients with Peripheral Artery Disease

Peripheral haemodynamic parameters are used to assess the presence and severity of peripheral artery disease (PAD). The prognostic value of ankle brachial index (ABI) has been thoroughly delineated. Nonetheless, the relative usefulness of ankle pressure (AP), ABI, toe pressure (TP), and toe brachial index (TBI) in assessing patient outcome has not been investigated in a concurrent study setting. This study aimed to resolve the association of all four non-invasive haemodynamic parameters in clinically symptomatic patients with PAD with cardiovascular mortality, overall mortality, and amputation free survival (AFS). In total, 732 symptomatic patients with PAD admitted to the Department of Vascular Surgery for conventional angiography at Turku University Hospital, Turku, Finland, between January 2009 and August 2011 were reviewed retrospectively. Demographic factors, cardiovascular mortality, all-cause mortality, and above foot level amputations were obtained and assessed in relation to AP, ABI, TP, and TBI by means of Kaplan-Meier life tables and a multivariate Cox regression model. The haemodynamic parameter that was associated with poor 36 month general outcome was TP < 30mmHg. Univariate Cox regression analysis of stratified values showed that TP and TBI associated significantly with mortality. In multivariate analysis both TP and TBI were associated with a significant risk of death. For TP < 30mmHg and TBI < 0.25 the risk of cardiovascular mortality was hazard ratio [HR] 2.84, 95% confidence interval [CI] 1.75-4.61 [p<.001]; HR 3.68, 95% CI 1.48-9.19 [p=.050], respectively; all-cause mortality (HR 2.05, 95% CI 1.44-2.92 [p<.001]; HR 2.53, 95% CI 1.35-4.74 [p=.040], respectively); and amputation or death (HR 2.13, 95% CI 1.52-2.98 [p<.001]; HR 2.46, 95% CI 1.38-4.40 [p=.050], respectively)... Among non-invasive haemodynamic measurements and pressure indices both TP and TBI appear to be associated with cardiovascular and overall mortality and AFS for patients with PAD presenting symptoms of the disease.

MSCs Isolated From Patients With Ischemic Vascular Disease Have Normal Angiogenic Potential

MSCs Isolated From Patients With Ischemic Vascular Disease Have Normal Angiogenic Potential

CRT-201 Can Ankle-Brachial Index or Ankle Pressure Be Used to Predict Wound Healing in Critical Limb Ischemia Patients?

The ankle pressure (AP) and ankle-brachial index (ABI) are inexpensive, sensitive and specific tests for the diagnosis of peripheral artery disease (PAD). In patients with critical limb ischemia (CLI), the decision to perform angiography and revascularization depends on appropriateness of blood flow

Association of diabetes and hemodialysis with ankle pressure and ankle-brachial index in Japanese patients with critical limb ischemia.

OBJECTIVETo investigate whether diabetes and regular hemodialysis are associated with false elevation of ankle systolic blood pressure and ankle-brachial systolic pressure index (ABI) because of their arterial calcification in patients with critical limb ischemia (CLI).RESEARCH DESIGN AND METHODSWe recruited 269 Japanese patients who underwent endovascular therapy for CLI. Ankle systolic blood pressure and ABI were assessed before endovascular therapy. Arterial stenosis and calcification were evaluated angiographically. We investigated the associations among clinical comorbidities, arterial calcification, and measurements of ankle systolic blood pressure and ABI.RESULTSAnkle systolic blood pressure was 85 ± 56 mmHg, and ABI was 0.59 ± 0.37. Arterial calcification was observed in 69% of the patients. The prevalence of diabetes and regular hemodialysis was 71 and 47%. Diabetes and regular hemodialysis were both significantly associated with the presence of arterial calcification; their adjusted odds ratios were 2.33 (P = 0.01) and 7.40 (P < 0.01), respectively. However, there was no significant difference in ankle systolic blood pressure or ABI level between those with and without these comorbidities. Furthermore, the presence of arterial calcification was not associated with ankle systolic blood pressure or ABI level, whereas arterial stenoses of all segments in the lower body had independent associations with reduced ankle systolic blood pressure and ABI level.CONCLUSIONSDiabetes and regular hemodialysis were significantly associated with arterial calcification, but not with elevated measurements of ankle systolic blood pressure or ABI, in CLI patients.

Deterioration of Ankle and Toe Brachial Pressure Indices (ABI-TBI) Values During a Hemodialysis (HD) Treatment Predicts Impaired Peripheral Circulation in HD Patients

Deterioration of Ankle and Toe Brachial Pressure Indices (ABI-TBI) Values During a Hemodialysis (HD) Treatment Predicts Impaired Peripheral Circulation in HD Patients

Clinical efficacy of IV prostaglandin E1and IV pentoxifylline in patients with arterial occlusive disease of fontaine stage IIb: A multicenter, randomized comparative study

The IV infusions of both prostaglandin E1 (PGE1) and pentoxifylline showed good efficacy in prolonging the claudication distance and maximum walking range of patients with intermittent claudication, and the Doppler pressures were used as parameters of efficacy. IV PGE1 was significantly superior after 4 weeks' therapy as to both claudication distance and maximum walking range. The ankle pressure indices were significantly elevated in both groups at the end of therapy. The therapeutic effect proved to persist in both groups after a 12 month follow-up, with adverse reactions occurring in two patients treated with PGE1 and in six patients treated with pentoxifylline. The study supports the view that the intravenous infusion of PGE1 is an efficacious and well-tolerated therapy for intermittent claudication.

Relationship between Serum Pre-B Cell Colony-Enhancing Factor/Visfatin and Atherosclerotic Parameters in Chronic Hemodialysis Patients

Pre-B cell colony-enhancing factor (PBEF)/visfatin is produced by adipose tissue, skeletal muscle, bone marrow, the liver and lymphocytes. Although serum PBEF/visfatin is related to the pathogenesis of atherosclerosis, and its level is elevated in patients with chronic kidney disease, it remains unclear whether increased PBEF/visfatin is associated with atherosclerotic parameters in hemodialysis (HD) patients. In this study, we measured serum PBEF/visfatin in 68 chronic HD patients (age 66 ± 14 years, time on HD 76 ± 76 months, 41 males, 27 females) and examined the association of serum PBEF/visfatin with serum asymmetric dimethylarginine, arteriosclerotic parameters such as pulse wave velocity, ankle brachial pressure index and the percent of abdominal aortic wall calcification in a cross-sectional fashion. Serum PBEF/visfatin was significantly correlated with time on HD (r = 0.29, p = 0.02), but not with age, gender and diabetes. There was no association between PBEF/visfatin and body mass index, abdominal visceral and subcutaneous fat mass area, and total adiponectin. Serum PBEF/visfatin was significantly positively correlated with log-transformed highly sensitive C-reactive protein (r = 0.26, p < 0.05) but negatively with serum albumin (r = –0.33, p < 0.01). In contrast, there was no association between serum PBEF/visfatin and asymmetric dimethylarginine, aortic pulse wave velocity, brachial ankle pressure index and percent of abdominal aortic wall calcification. It follows from these findings that serum PBEF/visfatin may reflect the inflammatory status rather than atherosclerotic changes in chronic HD patients.

Plasma sphingomyelin in subclinical atherosclerosis: findings from the multi-ethic study of atherosclerosis

Conclusion: Plasma sphingomyelin is a component of the biologic pathway mediating risk for subclinical atherosclerosis that is normally attributable to standard cardiovascular risk factors. Summary: Plasma sphingomyelin is an independent risk factor for coronary heart disease. In this study, the authors sought to determine the relation of plasma sphingomyelin to subclinical atherosclerotic disease. The relationship between plasma sphingomyelin and three different measurements of subclinical cardiovascular disease (ankle and arm blood pressure index, carotid intimal-medial thickness, and Agatston coronary artery and calcium score) were assessed. Study subjects included 6814 asymptomatic middle-aged adults from a multiethnic study of atherosclerosis first initiated in 2000. Plasma sphingomyelin levels correlated positively with lipid levels and the Framingham risk score (P < .01 for both). The mean level of plasma sphingomyelin was higher in women than men (50 ± 16 mg/dL vs 45 ± 15 mg/dL, P < .01). Plasma sphingomyelin levels were higher in never (49±16 mg/dL) vs current smokers (45±17 mg/dL, P < .01). Levels of subclinical vascular disease as assessed by all three measures were higher in women with sphingomyelin levels of ≥60 mg/dL than in women with sphingomyelin levels of <39 mg/dL. This association did not remain significant after multivariant adjustment for standard cardiovascular risk factors. Men with sphingomyelin levels of >60 mg/dL had higher calcium scores (135 vs 99 Agatston units, P = .01) than men with sphingomyelin levels <39 mg/dL. Comment: Sphingomyelin accumulates in atheromas in animal models and in human atheroma. Much sphingomyelin found in arteries arises from synthesis within the arterial tissue (Circulation 1961;23:370-5). However, synthesis of sphingomyelin within arterial tissue appears slow compared with the total amount accumulated, suggesting plasma levels of sphingomyelin may also contribute to accumulation of sphingomyelin within arterial tissue. The unadjusted data from this study provide some support that plasma sphingomyelin is a component of a pathway that mediates risk for subclinical disease attributable to traditional cardiovascular risk factors.

Douleurs ambiguës “de hanche” ou de fesse, artérite proximale ou canal lombaire sténosé?

Proximal arterial stenosis (bifurcation of the aortic, common iliac and especially hypogastric or hip arteries) can cause misleading 'hip' or buttock pain (two thirds of these cases involve the area of the trochanter, groin, or thigh). Their essential characteristic is that they cause patients to stop walking, improve in a minute or two and reappear when the patient starts walking again. Neither articular complications nor periarthritis of the hip fit this pattern, and physical examination and imaging exclude them. Neurogenic intermittent claudication is more difficult to rule out: it is 'often accompanied by paresthesia and anteflexion of the trunk to relieve the pain. A radiologic image of lumbar canal stenosis alone does not indicate that it is responsible for the pain: the stenosis may be asymptomatic and only fortuitously associated with the pain. The usual reduction in femoral pulse or ankle pressure index is absent if the stenosis is located on the hypogastric or gluteal artery and there is not substantial damage to the aorta-iliac axis. Arterial stenosis is confirmed by Doppler ultrasound. Arteriography is an examination performed during treatment, to guide angioplasty. It is indicated when medical treatment fails, as it frequently does.

Axillofemoral and femorofemoral grafts: a 6-year experience with emphasis on the relationship of peroperative flow measurement to graft survival.

Over a 6-year period 64 axillofemoral bypass and femorofemoral crossover grafts have been performed in 58 patients, most of whom were considered unfit for intra-abdominal surgery. Indications were peripheral ischaemia in 78 per cent and disabling claudication in 22 per cent. The limb salvage rate at 3 years was 75 per cent. No claudicants lost limbs, but only one-third of patients presenting with forefoot gangrene or ulceration avoided amputation. Most patients presenting with ischaemic symptoms at rest had associated femoropopliteal and distal disease, confirmed by the ankle pressure index measurements, and this influenced graft patency. Although the cumulative patency at 3 years for all grafts combined was 57 per cent with similar patencies for both the axillofemoral and femorofemoral grafts, early occlusion was more common in axillofemoral grafts and this may be reduced in bifemoral grafts by the increased flow rate in the vertical limbs. Peroperative electromagnetic flowmeter measurements were made after reconstruction on 55 femoral arteries in 46 of the patients and graft flow velocities were derived from these measurements. Comparison between velocities from those grafts remaining patent and those subsequently occluding showed a high incidence of occlusion in grafts with a maximal velocity after distal vasodilatation of less than 8 cm/s. Graft occlusion after the first postoperative month was more commonly associated with other factors such as continued smoking, severity of distal disease and perigraft infection.

Hepatocyte growth factor as potential cardiovascular therapy

Hepatocyte growth factor is a mesenchyme-derived pleiotropic factor that regulates the growth, motility and morphogenesis of various types of cells, and is also a member of the angiogenic growth factors. Hepatocyte growth factor is secreted by vascular endothelial cells and smooth muscle cells, and the hepatocyte growth factor receptor, c-met, was also observed in these vascular cells. Treatment of human aortic endothelial cells with recombinant hepatocyte growth factor resulted in a significant increase in cell proliferation, accompanied by mitogen-activated protein kinase and Akt/protein kinase B phosphorylation. Recently, a novel therapeutic strategy for ischemic diseases using angiogenic growth factors to augment collateral artery development has been proposed. As preclinical study of gene therapy using hepatocyte growth factor to treat peripheral arterial disease, naked hepatocyte growth factor plasmid was intramuscularly injected into the ischemic hind limb of rabbits in order to evaluate its angiogenic activity. Intramuscular injection of hepatocyte growth factor plasmid once on day 10 following surgery, produced significant augmentation of collateral vessel development in the ischemic limb on day 30. In the clinical setting, the authors further investigated the safety and efficacy of hepatocyte growth factor plasmid DNA in patients with critical limb ischemia, in a prospective open-labeled trial. Intramuscular injection of naked plasmid DNA was performed in the ischemic limbs of six patients with critical limb ischemia with arteriosclerosis obliterans (n = 3) or Buerger disease (n = 3) graded as Fontaine III or IV. In the efficacy evaluation, a reduction of pain scale of more than 1 cm on a visual analog pain scale was observed in five out of six patients. An increase in ankle pressure index of more than 0.1 was observed in five out of five patients. The long diameter of eight out of 11 ischemic ulcers in four patients was reduced by more than 25%. Intramuscular injection of naked hepatocyte growth factor plasmid is safe, feasible and can achieve successful improvement of ischemic limbs. Although the present data were obtained to demonstrate safety in a Phase I/early Phase II trial, the initial clinical outcome with hepatocyte growth factor gene transfer seems to indicate its usefulness as sole therapy for critical limb ischemia. Randomized placebo-controlled clinical trials of alternative dosing regimens of gene therapy will be required to define the efficiency of this therapy.

The Case for Intermittent Pneumatic Compression of the Lower Extremity as a Novel Treatment in Arterial Claudication

Appreciation of the physiologic role of the natural muscle pumps of the lower limb in enhancing the return of venous blood promoted the development of intermittent pneumatic limb compression (IPC) systems that could activate these pumps artificially. The application of IPC to the foot (IPC(foot)), calf (IPC(calf)) or both (IPC(foot + calf)) on dependency generates a significant acute arterial leg inflow enhancement in patients with intermittent claudication that is highest with IPC(foot + calf), followed by IPC(calf) and IPC(foot). This enhancement is attributable to the leg venous pressure decrease after venous expulsion with IPC, which results in arteriovenous pressure elevation, and a marked attenuation in peripheral resistance to flow due to a transient abolition of peripheral sympathetic autoregulation and the release of nitric oxide. Implementation of IPC(foot) and IPC(foot + calf) for 3 to 5 months (> or = 2.5 hours/day) has been shown to improve the walking capacity and the ankle pressure indices of patients with intermittent claudication, with a significant beneficial impact on the quality of life. As the prevalence of symptomatic peripheral arterial disease is projected to increase substantially over the next decades with the aging population in Western societies and in the absence of established, cost-effective methods of treatment for claudication, the reported efficacy of IPC in claudication certainly warrants clinical attention. Level-1 clinical evidence by three independent investigators supports the clinical role of IPC in arterial claudication, reinforced by its domiciliary applicability, the high patient compliance with which it is associated, and the modest cost. This review offers an insight into the hemodynamic and clinical effects of IPC in patients with claudication in relation to the physiologic mechanisms proposed in explanation of these effects.

Assessing peripheral arteries in South African black women with type 2 diabetes mellitus

To determine the value of ankle and toe blood pressure indices and pedal pulse palpation in the assessment of peripheral arterial disease in subjects with type 2 diabetes mellitus (DM). Cross-sectional study. A convenience sample of 85 female subjects with type 2 DM underwent a series of peripheral vascular assessments at the diabetes clinic of a community hospital. Palpation of the pedal pulses, Doppler-derived ankle brachial systolic blood pressure indices, photo plethysmographic-derived toe brachial systolic blood pressure indices and antero-posterior radiographs of both feet. Mean values were 1.15 (standard deviation (SD): 0.17) and 0.76 (SD: 0.17) for ankle brachial index (ABI) and toe brachial index (TBI) respectively. The differences between the two indices increased from 0.36 (95% confidence interval (CI): 0.32-0.41) to 0.58 (95% CI: 0.46-0.70) depending on whether ABI was less or greater than 1.3. The correlation coefficient for left versus right foot was 0.62 and 0.71 for ABI and TBI respectively. The relationship between ABI and TBI is non-linear with a cut point close to 1.3. Both ABI and TBI were significantly lower in subjects who had both pedal pulses absent on palpation. The relationship between ABI and TBI is linear below an ABI of 1.3. but with a wide 95% prediction interval. If both pedal pulses are absent the ABI is significantly diminished compared with when both pulses are present, even though not necessarily below 0.9.

Safety Evaluation of Clinical Gene Therapy Using Hepatocyte Growth Factor to Treat Peripheral Arterial Disease

Therapeutic angiogenesis using angiogenic growth factors is expected to be a new treatment for patients with critical limb ischemia (CLI). Because hepatocyte growth factor (HGF) has potent angiogenic activity, we investigated the safety and efficiency of HGF plasmid DNA in patients with CLI as a prospective open-labeled clinical trial. Intramuscular injection of naked HGF plasmid DNA was performed in ischemic limbs of 6 CLI patients with arteriosclerosis obliterans (n=3) or Buerger disease (n=3) graded as Fontaine III or IV. The primary end points were safety and improvement of ischemic symptoms at 12 weeks after transfection. Severe complications and adverse effects caused by gene transfer were not detected in any patients. Of particular importance, no apparent edema was observed in any patient throughout the trial. In addition, serum HGF concentration was not changed throughout the therapy period in all patients. In contrast, a reduction of pain scale of more than 1 cm in visual analog pain scale was observed in 5 of 6 patients. Increase in ankle pressure index more than 0.1 was observed in 5 of 5 patients. The long diameter of 8 of 11 ischemic ulcers in 4 patients was reduced >25%. Intramuscular injection of naked HGF plasmid is safe, feasible, and can achieve successful improvement of ischemic limbs. Although the present data are conducted to demonstrate the safety as phase I/early phase IIa, the initial clinical outcome with HGF gene transfer seems to indicate usefulness as sole therapy for CLI.

Risk Factors for Peripheral Neurovascular Dysfunction in Patients With Diabetes Mellitus and Arteriosclerosis Obliterans: A Pilot Study

PURPOSETo develop a nursing diagnostic tool to help prevent foot disease in patients with diabetes mellitus at risk for developing peripheral neurovascular dysfunction.METHODSSubjects were 24 patients with diabetes mellitus. Ankle pressure index, percutaneous oxygen partial pressure (PtcO2), and circulation in the foot were measured using a laser flow meter. Neurologic disorders were evaluated using the Achilles reflex, sensory tests, and taste tests. Basic data (age, gender, fasting blood glucose as an indicator of the duration and severity of disease, hemoglobin, total cholesterol, lipids) were gathered from medical records. Patients were divided into two groups: those who had arteriosclerosis obliterans (10 males, 5 females) and those who did not (5 males, 4 females).FINDINGSThere was a significant decrease in ankle pressure, PtcO2, and sensory perception in the feet of those with arteriosclerosis obliterans. There was also a significant decrease in taste sensation in this group.CONCLUSIONSThese results suggest that patients with diabetes mellitus who have arteriosclerosis obliterans are already at risk for developing neurologic disorders and arteriosclerosis in the lower limbs. Clinical symptoms measured were able to determine risk for peripheral neurovascular dysfunction in patients with diabetes. The screening and assessment of these risk factors is noninvasive, making it possible for nurses to perform them by using their assessment skills.

Effects of beraprost sodium (Dorner) in patients with diabetes mellitus complicated by chronic arterial obstruction.

The effects of the prostaglandin I2 derivative beraprost sodium (Dorner) on ankle pressure index (AP; ankle joint-to-upper extremity systolic pressure ratio), subjective symptoms, and intermittent claudication were investigated in diabetic patients with arteriosclerosis obliterans (ASO). Forty patients (25 men and 15 women), mean age 63.9 years, were enrolled in this study. ASO was grade I in 30 patients, grade II in seven, grade III in one, and grade IV in two according to the Fontaine classification. They were administered six tablets (20 microg/tablet) of beraprost sodium daily for 6 months. At 3 and 6 months, API had significantly increased and symptoms such as coldness, numbness, and lack of feeling in the lower extremities were significantly improved. Ten evaluable patients increased ambulatory distance by approximately threefold, suggesting an improvement in intermittent claudication. Adverse reactions were experienced by five (12.5%) of the 40 patients (one case each of headache, dull headache, pain in the posterior region of the neck, heartburn, stomach discomfort, and anemia), but all were mild and resolved without treatment. Beraprost sodium was shown to improve API and symptoms in the lower extremities in diabetic patients with ASO, suggesting that it is useful in treating peripheral circulatory disorders in such patients.

Improvement in walking ability, ankle pressure indices and quality of life in vascular claudication using intermittent pneumatic foot and calf compression: a randomized controlled trial

Abstract Background Perioperative mortality, graft failure and limitations of balloon angioplasty mitigate against active intervention for claudication. With the exception of exercise programmes, conservative treatments yield modest results. Intermittent pneumatic compression (IPC) of the foot used daily for over 3 months enhances significantly the walking ability and pressure indices of stable claudicants. This prospective randomized study evaluated the effects of IPC of the foot and calf simultaneously (IPCfoot + calf) on the walking ability, arterial haemodynamics and quality of life of patients with intermittent claudication. Methods Forty-one stable claudicants, meeting stringent inclusion and exclusion criteria, were randomized to receive either IPCfoot + calf and 75 mg aspirin (group 1; n = 21) or 75 mg aspirin alone (group 2; n = 20), with stratification for diabetes and smoking. Groups matched for age, sex, initial (ICD) and absolute (ACD) claudication distance, ankle: brachial pressure index (ABPI), popliteal artery flow (Q) and quality of life (Short Form (SF) 36 questionnaire). IPCfoot + calf (120 mmHg, three cycles per min, inflation 4 s, proximal inflate delay 1 s) was used for 2·5 h daily for 5 months consecutively. Both groups were advised to exercise unsupervised. Evaluation of patients, after randomization, included: (a) ICD and ACD on a treadmill, (b) resting and postexercise ABPIs, (c) Q using duplex imaging, and (d) quality of life. Study time-points were: baseline and 1, 2, 3, 4, 5 and 17 months. Compliance was assessed by means of a log book. Non-parametric statistical analysis was used (Wilcoxon and Mann–Whitney tests). Results After 5 months of IPCfoot + calf median ICD, ACD, resting and postexercise ABPI in group 1 increased by 197, 212, 17 and 64 per cent (all P &amp;lt; 0·001) respectively; changes in group 2 were all non-significant (P &amp;gt; 0·1). On intergroup comparison at 5 months, patients in group 1 were better than those in group 2 in terms of ICD, ACD, resting and postexercise ABPI (all P &amp;lt; 0·01). Q changes within this period were not significant in either group; neither were intergroup Q differences (P &amp;gt; 0·1). Associated changes in the quality of life within group 1 at the end of month 5 were significant; non-significant changes were noted in group 2. At 5 months patients in group 1 enjoyed a better quality of life than those in group 2 (P &amp;lt; 0·01). IPCfoot + calf use did not result in any complications. The daily IPCfoot + calf compliance (2·5 h per day) was greater than 82 per cent in the first month and greater than 85 per cent in months 2–5. One year after the end of IPCfoot + calf application, patients in group 1 maintained the improved ABPI and walking benefit. Conclusion IPCfoot + calf emerged as an effective, high-compliance, uncomplicated method for improving the walking ability and pressure indices in patients with stable claudication, with a confirmed durable outcome. These changes are associated with a significant improvement in all aspects of quality of life evaluated by the SF-36. Despite a limited benefit noted in some individuals, unsupervised exercise had a non-significant impact overall.

THE EFFECT LDL APHERESIS ON PERIPHERAL CIRCULATION

[Background and Purpose] Low density lipoprotein(LDL) apheresis is one type of therapy that is currently being used for the treatment of coronary arterial disease. However, there have been few studies made to clarify the effectiveness of LDL apheresis on arteriosclerosis obliterans (ASO). In this study, we evaluated the clinical features of ASO during consecutive LDL apheresis treatment. [Methods] Five patients who were excluded from the treatment of intervention and surgery, were introduced to treatment of LDL apheresis. For each of the those five patients, we measured the temperature of the toe next to the large toe by thermograph, popliteal arterial blood flow by the Doppler Method, and ankle pressure index(API) by Matsuo's Method, and then evaluated the results of those measurements. The patients received LDL apheresis therapy once a week for ten consecutive weeks. [Results] All five patients showed significant improvement in temperature and API (Table).Table[Conclusion] LDL apheresis therapy improved peripheral circulation markedly and, therefore, maybe a good therapeutic choice of treatment for ASO.