Symptoms Of Intermittent Claudication Research Articles

New Horizons in Peripheral Artery Disease.

Peripheral artery disease (PAD) is the lower limb manifestation of systemic atherosclerotic disease. PAD may initially present with symptoms of intermittent claudication, whilst chronic limb-threatening ischaemia (CLTI), the end stage of PAD, presents with rest pain and/or tissue loss. PAD is an age-related condition present in over 10% of those aged ≥65 in high-income countries. Guidelines regarding definition, diagnosis and staging of PAD and CLTI have been updated to reflect the changing patterns and presentations of disease given the increasing prevalence of diabetes. Recent research has changed guidelines on optimal medical therapy, with low-dose anticoagulant plus aspirin recommended in some patients. Recently published randomised trials highlight where bypass-first or endovascular-first approaches may be optimal in infra-inguinal disease. New techniques in endovascular surgery have increased minimally invasive options for ever more complex disease. Increasing recognition has been given to the complexity of patients with CLTI where a high prevalence of both frailty and cognitive impairment are present and a significant burden of multi-morbidity and polypharmacy. Despite advances in minimally invasive revascularisation techniques and reduction in amputation incidence, survival remains poor for many with CLTI. Shared decision-making is essential, and conservative management is often appropriate for older patients. There is emerging evidence of the benefit of specialist geriatric team input in the perioperative management of older patients undergoing surgery for CLTI. Recent UK guidelines now recommend screening for frailty, cognitive impairment and delirium in older vascular surgery patients as well as recommending all vascular surgery services have support and input from specialist geriatrics teams.

Does frailty affect barriers to physical activity in patients with symptomatic peripheral artery disease? A cross-sectional study

BackgroundFrailty syndrome is prevalent among many patients experiencing intermittent claudication symptoms. Considering that components of the frailty syndrome can affect both physical and psychological functions, it is likely that barriers to physical activity are heightened in these individuals. AimTo analyze the association between barriers to physical activity and frailty in patients with symptomatic peripheral artery disease (PAD). MethodsThis cross-sectional study included 216 patients with symptomatic PAD (64.8% men, 65.6±9.4 yrs.). Nine personal and 8 environmental barriers to physical activity were investigated through a questionnaire on barriers to practicing physical activity in patients with intermittent claudication. Frailty was defined according to Fried et al. (2001) criteria which included unintentional weight loss, exhaustion, low grip strength, slow walking speed, physical inactivity. Three or more criteria defined frail, one or 2 criteria defined pre-frail, and absence of criteria defined non-frail. Data are presented as median (interquartile range). ResultsFrail and pre-frail patients have more barriers than non-frail patients [frail: 11 (4); pre-frail: 10 (6); non-frail: 8 (7), p = 0.001]. Absence of a companion for physical activity, lack of knowledge and uncertainty about the benefits of physical activity, pain induced by walking and presence of obstacles that worsen leg pain were associated with frail and pre-frail status, independent of sex, age, ankle-brachial index, and total walking distance. ConclusionPatients with PAD who are frail and pre-frail have more barriers to physical activity than non-frail patients. Therefore, specific interventions promoting PA are essential for these patients to improve their health outcomes.

Unilateral biportal endoscopic lumbar interbody fusion (ULIF) versus endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) in the treatment of lumbar spinal stenosis along with intervertebral disc herniation: a retrospective analysis

ObjectiveThis study aims to compare the clinical effects and imaging data of patients who underwent endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) with those who received unilateral biportal endoscopic lumbar interbody fusion (ULIF).MethodsA retrospective analysis was conducted on the clinical data of 69 patients presenting with typical intermittent claudication and signs and symptoms indicative of unilateral lower extremity nerve root compression, meeting inclusion criteria between April 2022 and June 2022. Among the cohort, 35 patients underwent ULIF group, while 34 patients underwent Endo-TLIF group. We compared perioperative parameters, including intraoperative blood loss, duration of hospital stay, and operation time between the two groups. Pre-operative and post-operative changes in the height and cross-sectional area of the target intervertebral space were also compared between the groups. Finally, we evaluated bone graft size and interbody fusion rates at 6 and 12 months post-surgery using the Brantigan scoring system.ResultsThe ULIF group had significantly shorter operative times compared to the Endo-TLIF group (P < 0.05). Conversely, the Endo-TLIF group exhibited significantly shorter hospital stays compared to the ULIF group (P < 0.05). However, there were no significant differences in intraoperative bleeding between the two groups (P > 0.05). Furthermore, both groups exhibited postoperative increases in vertebral canal volume compared to baseline (P < 0.05), with no significant difference in the change in the cross-sectional area of the target intervertebral space between the two surgical methods (P > 0.05). Interbody fusion rates were comparable between the two groups at both 6 and 12 months after surgery (P > 0.05). Lastly, the ULIF group had a significantly larger area of bone graft than the Endo-TLIF group (P < 0.05).ConclusionIn summary, the ULIF technique, as a novel spinal endoscopy approach, is a safer and more effective minimally invasive surgical method for addressing lumbar spinal stenosis and intervertebral disc herniation in patients. Both surgical methods have their own advantages and drawbacks. With the development of technology and related instruments, the limitations of both techniques can be mitigated for to a certain extent, and they can be applied by more doctors in diverse medical fields in the future.

Sex and Racial Disparities in Peripheral Artery Disease.

Several studies have shown that women and racial and ethnic minority patients are at increased risk of developing lower extremity peripheral artery disease and suffering adverse outcomes from it, but a knowledge gap remains regarding the underlying causes of these increased risks. Both groups are more likely to be underdiagnosed, have poorly managed contributory comorbidities, and incur disparities in treatment and management postdiagnosis. Opportunities for improvement in the care of women and racial and ethnic minorities with peripheral artery disease include increased rates of screening, higher rates of clinical suspicion (particularly in the absence of typical symptoms of intermittent claudication), and more aggressive risk factor management before and after the diagnosis of peripheral artery disease.

The Role of Ankle Brachial Index in Patient with Peripheral Arterial Disease; Diagnostic and Prognostic Tool

Objectives: Peripheral arterial disease is an independent risk factor for developing major cardiovascular events, and even death; this makes its diagnosis important in early detection and prevention of these events. Ankle brachial index is a non-invasive, simple, bedside screening, diagnostic and even prognostic tool, patients with ABI less than 0.9 were found to have PAD, and at risk of cardiovascular events. Methods: A descriptive cross-sectional study of 338 patients was conducted during the period October 2021 to December 2022. They were referred to vascular and endovascular surgery unit at Ghazi Al-Hariri multispecialty teaching hospital/ Medical city teaching, they were presented with intermittent claudication and other PAD symptoms. Peripheral endovascular angioplasty was done; all were subjected to Ankle brachial index measurement. Results: The study involves 338 patients, among them males were 242 (72%), females were 96 (28%). Age ranged from 25-92 years old, with an age average of 61 years. A total of 203 (60%) were presented with classical lower limb claudication, 100 (30%) patients with atypical symptoms and only 35 (10%) patients with critical limb ischemia. A total of 216 (64%) patients with ABI between 0.4-0.9; 100 (29%) patients with ABI greater than 0.9; 19 (6%) patients with ABI less than 0.4, and only 3(1%) patients with ABI more than 1.4. Conclusion: Ankle brachial index is a useful, cost effective, simple non-invasive diagnostic tool in patients with peripheral arterial disease.

Home-Based Exercise Therapy in the Management of Intermittent Claudication: A Systematic Review and Meta-Analysis.

The current literature strongly supports the use of supervised exercise therapy (SET) as the first-line treatment for symptomatic peripheral arterial disease (PAD) such as intermittent claudication (IC). However, this form of treatment remains underutilised in clinical practice. The home-based exercise therapy (HBET), in which patients must conduct themselves unsupervised is generally less effective than SET in terms of improving functional walking capacity. Nevertheless, it may be a useful alternative where SET is unavailable. The objective of this systematic review is to determine the effectiveness of HBET in reducing symptoms of IC in patients with PAD. Studies eligible for inclusion in this systematic review were parallel-group randomised controlled trials (RCTs) published in the English language that compared the effect of HBET to a comparator arm (SET or no exercise/attention control) in adults with PAD and IC. Studies were eligible if outcome measures were available at baseline and at 12 weeks of follow-up or more. The electronic databases PubMed, Google Scholar, and the Cochrane Library were searched from the earliest records up to January 2021. The Cochrane Collaboration risk of bias tool for RCTs (RoB 2)was used to assess the risk of bias in individual studies, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) classification system was used to appraise the quality of evidence for each outcome across all studies. The primary investigator independently collected, pooled, and analysed the data. The data was then entered into the ReviewManager 5 (RevMan 5) software, and a meta-analysis was performed by using a fixed or random effects model depending on the presence or absence of statistical heterogeneity. The review author identified seven RCTs involving a total of 754 patients which were included in this study. Overall, the risk of bias in the included studies was moderate. Even though the results were variable, this analysis supported the ability of HBET to improve functional walking capacity and self-reported quality of life (QoL) to an extent. This review shows that a home-based exercise intervention with regular professional support and encouragement is beneficial in improving functional walking capacity as well as some aspects of QoL in patients with PAD and IC when compared to no exercise. However, when HBET is compared to hospital-based supervised exercise intervention, SET yields greater benefits.

Chronic Complete Distal Aortic Occlusion and Pulmonary Embolism—Atypical Antiphospholipid Syndrome?

Complete aortic occlusion is a rare pathology with various possible etiologies. According to current data, it is most frequently caused by atherosclerosis. However, thrombosis or vasculitis could also be involved. We present the case of a 42-year-old female with chronic complete distal aortic occlusion, associated pulmonary embolism and positive antiphospholipid antibodies. The patient had an obstetric history suggestive of antiphospholipid syndrome (APS). She presented with typical intermittent claudication symptoms persisting for approximately five years at the time of admission. Arteriography revealed complete infrarenal aortic occlusion and the presence of collateral arteries. Aortoiliac bypass surgery was performed. This case emphasizes an unusual, yet possible, etiology of chronic aortic occlusion-most probably, combining atherosclerosis and chronic thrombosis-in a relatively young patient, in which the diagnosis was significantly delayed due to the peculiar association of traits.

Influence of Lower Limb Ischemia on Skeletal Muscle Mass Depletion in Patients with Peripheral Artery Disease

The aim of the study was to determine the change in skeletal muscle mass over time by bioelectrical impedance analysis (BIA) in patients with peripheral artery disease (PAD). Patients with symptomatic PAD visiting Tokyo Medical University Hospital between January 2018 and October 2020 were retrospectively analyzed. PAD was diagnosed based on ankle brachial pressure index (ABI)<0.9 with either leg and confirmed by duplex scan and/or computed tomography angiography as needed. Patients undergoing endovascular treatment, surgery, or supervised exercise therapy were excluded before and during the study period. Skeletal muscle mass of the extremities was measured using BIA. The sum of skeletal muscle masses in the arms and legs was calculated as skeletal muscle mass index (SMI). Patients were scheduled to undergo BIA at an interval of 1year. Of 119 patients, 72 patients were included in the study. All patients were ambulatory and had symptoms of intermittent claudication (Fontaine's stage II). SMI significantly decreased from 6.98±1.30 at baseline to 6.83±1.29 at 1-year follow-up. Individual skeletal muscle mass of the ischemic leg was significantly reduced after 1year, but not in the nonischemic leg. A decrease in SMI (defined as SMI ≥0.1kg/m2 per year) was independently associated with low ABI. The optimal cut-off value of ABI for the decrease in SMI was 0.72. These results suggest that lower limb ischemia due to PAD, especially if ABI is<0.72 or less, may result in a decrease in skeletal muscle mass that affects health and physical function.

Correlation of clinical signs and magnetic resonance imaging findings in patients with lumbar spondylosis.

The purpose of the study was to contribute further to this debated topic by investigating the correlation of magnetic resonance imaging (MRI) findings with the clinical picture in lumbar spondylosis patients. This multicenter retrospective study (as part of the epidemiological project of the TLAR-OASG [Turkish League Against Rheumatism-Osteoarthritis Study Group]) included 514 patients (101 males, 413 females; mean age: 63.6±10.8 years; range, 40 to 85 years) who were diagnosed as lumbar spondylosis by clinical examination and direct X-ray between December 2016 and June 2018. Demographic characteristics of patients, Visual Analog Scale for pain, presence of radiating pain, Roland-Morris disability questionnaire, straight leg raise test, deep tendon reflexes, neurogenic intermittent claudication symptoms, any decrease of muscle strength, and abnormality of sensation were recorded. Lumbar MRI findings of the patients were recorded as positive or negative in terms of disc herniation, intervertebral disc degeneration, root compression, osteophytes, spinal stenosis. Statistical analysis was done to assess the correlation between the clinical symptoms, physical examination, and MRI findings. Correlation analysis of the MRI results and the clinical findings showed a significant correlation between straight leg raise test and root compression (p<0.001, r=0.328) and a significant correlation between neurogenic intermittent claudication and spinal stenosis (p<0.001, r=0.376). Roland-Morris disability questionnaire had a significant correlation with all MRI findings (p<0.05, r<0.200). The results of this study corroborate the notion that diligent patient history and physical examination are more valuable than MRI findings, even though a higher incidence of abnormal MRI findings have been obtained in patients with disability and dermatomal radiating pain.

Reference values for triceps surae tissue oxygen saturation by near-infrared spectroscopy

Objective. To establish the reference values for peripheral tissue perfusion of the triceps surae muscle assessed by Near-infrared spectroscopy (NIRS) at rest and in progressive effort. Approach. A total of 288 apparently healthy individuals of both sexes were included; between 30 and 79 years of age; nonsmokers; without diagnosis of diabetes mellitus, systemic arterial hypertension, kidney disease, symptoms of angina and intermittent claudication, or any musculoskeletal alteration that would prevent physical exertion; and without diagnosis of Peripheral arterial disease (PAD) or other associated symptoms. All individuals performed anthropometric measurements, physical activity levels, and tissue oxygen saturation (StO2) assessments by NIRS during and after arterial occlusion maneuver and incremental shuttle walking test. The variables obtained by NIRS were presented in percentiles (P) for general comparison between sexes and for comparison between sexes according to age group. The relationship between the NIRS data and other variables was tested. Main results. Considering P50 and p<0.05, men had lower StO2 values, higher deoxygenation and reoxygenation (Tx-reox) rates at rest, and higher Tx-reox during progressive effort. There were correlations (p<0.0001) of body composition with the lowest StO2 and Tx-reox values and of functional capacity with Tx-reox in occlusion and Tx-reox. Significance. The percentiles presented can clinically assist in the diagnosis and monitoring of different health conditions; however, it is important to consider the individual’s sex, body composition, and functional capacity.

Hybrid revascularization of chronic occlusion of the aorto-femoral segment in a patient with critical ischemia of the lower limbs and ischemic heart disease

Backgound. The number of patients with Leriche’s syndrome has increased dramatically. Despite the compensatory development of collaterals, this condition most often leads to symptoms of intermittent claudication and can result in critical ischemia and amputations. TASC II guidelines recommend reconstructive surgery, but this approach is associated with high perioperative mortality. So far, only few studies reported the results of endovascular correction of the atherogenic process in the infrarenal aorta.Objective. To present a clinical case of hybrid revascularization of the aortofemoral segment in a patient with ischemic heart disease.Design and methods. A 68-year-old patient with Leriche’s syndrome underwent ultrasound of the brachiocephalic arteries, coronary angiography, and multispiral computed tomography with angiography. Subsequently, hybrid surgery was performed.Results. Given the critical ischemia of the lower extremities and comorbidities, a hybrid surgical intervention was performed: endarterectomy from the femoral arteries and endovascular recanalization of the occlusion of the aortoiliac segment using the “kissing stents” technique.Conclusions. The requirements for equipment and experience of the surgical team limit the widespread use of hybrid correction of an occlusive lesion of the infrarenal aorta. The lack of randomized trials creates uncertainty in the choice of revascularization tactics. In the framework of this clinical case, the effectiveness of hybrid surgery in the treatment of a patient with multifocal atherosclerosis has been proven.

State-of-the-Art Endovascular Therapies for the Femoropopliteal Segment: Are We There Yet?

Peripheral arterial disease is an increasingly prevalent condition with significant associated morbidity, mortality, and health care expenditure. Endovascular interventions are appropriate for most patients with either ongoing symptoms of intermittent claudication despite lifestyle and medical optimization or chronic limb-threatening ischemia. The femoropopliteal segment is the most common arterial culprit responsible for claudication and the most commonly revascularized segment. Endovascular approaches to revascularization of the femoropopliteal segment are advancing with an evolving landscape of techniques for arterial access, device-based therapies, vessel preparation, and intraprocedural imaging. These advances have been marked by debate and controversy, notably related to the safety of paclitaxel-based devices and necessity of atherectomy. In this review, we provide a critical overview of the current evidence, practice patterns, emerging evidence, and technological advances for endovascular intervention of the femoropopliteal arterial segment.

Implementation of supervised exercise therapy in a veteran population with symptomatic claudication.

Real-world implementation of supervised exercise therapy (SET) referral for symptomatic intermittent claudication has been limited by poor provider awareness around reimbursement and low patient adherence owing to factors including limited center availability and long travel distances to sites. In this study, 76 of 77 consecutive male veteran patients with intermittent claudication managed at a single-center vascular specialty clinic were referred to SET prior to revascularization. Pre- and post-SET submaximal exercise treadmill testing was performed for assessment of exercise capacity in metabolic equivalents (METs). In the 48.7% of subjects who completed 36 sessions of SET (n = 37), the average improvement in METs was 60.3%, reflecting improvement from baseline average of 3.4 METs to 5.5 METs after SET. Another 14 patients pursued self-guided exercise therapy and 25 patients declined any participation in exercise therapy. Reasons for declining participation in SET included inadequate transportation, cost of copayment, and interference with full-time work schedules. There was a nonsignificant numeric trend toward improved change in ankle-brachial index in the combined SET and self-guided exercise groups compared to those that declined exercise therapy (0.011 ± 0.124 vs -0.040 ± 0.105, p = 0.156). High acceptance of referral to SET is possible, despite the limitations to implementation. Incorporation of novel pre- and post-SET submaximal exercise treadmill testing allows for assessment of change in exercise capacity and aids in risk stratification and management of intermittent claudication symptoms.

A single-center retrospective analysis of 77 traumatic arterial injuries of lower extremities

Objective: To analyze the treatment and clinical prognosis of lower extremity arterial injury caused by trauma. Methods: The clinical data of 77 patients with traumatic lower extremity arterial injury admitted to Department of Vascular Surgery,Yichang Central People's Hospital from January 2013 to June 2021 were collected retrospectively. There were 65 males and 12 females, with an average age of 47.4 years (range: 7 to 75 years). Among the 77 patients, 56 cases (72.7%) had open injury and 21 cases (27.3%) had closed injury. Iliac artery was injured in 9 cases (11.7%), common femoral artery in 7 cases (9.1%), superficial femoral artery in 1 case (1.3%), popliteal artery in 11 cases (14.3%) and inferior knee artery in 49 cases (63.6%). The treatment methods and clinical effects were analyzed. Results: One case with pelvic fracture combined the internal iliac artery injury and 1 case with multiple injuries involving the common femoral artery died of circulatory failure before surgery. Seventy-five cases received vascular-related operations, including arterial ligation in 24 cases, arterial reconstruction in 40 cases, stent graft implantation in 1 case, primary amputation in 2 cases, and arterial embolization in 8 cases. The overall mortality rate was 6.5% (5/77), all of which were closed injuries. Except for 2 cases who died before surgery, 3 cases with pelvic fracture combined the internal iliac artery injury died of multiple organ failure after internal iliac artery embolization. There were 8 cases received amputation (10.4%, 8/77), 5 cases with closed injury and 3 cases with open injury. In addition to 2 cases with primary amputation, 6 cases underwent secondary amputation due to ischemia-reperfusion injury after revascularization (4 cases with popliteal artery injury and 2 cases with subpatellar artery injury). The average followed-up time was 17 months (range: 2 months to 8 years). One patient with femoral artery injury underwent autologous great saphenous vein bypass, and lower limb artery CT angiography was re-examined 6 months after the operation, and 30% distal anastomotic stenosis was found. Ankle brachial index<0.8 was found in two patients 1 year after popliteal artery repair, but none of the patients had intermittent claudication symptoms, and no further intervention was performed. Five patients suffered delayed healing due to severe lower limb injury, fracture and skin injury. Among them, 2 cases had poor wound healing at the stump of amputation, which gradually healed 3 to 5 months after several debridements. The other 3 vascular injury combined with tibial fracture patients had delayed tibial healing after surgery, but no symptoms of vascular ischemia occurred. All the other patients recovered well and no other serious complications occurred. Conclusions: The proportion of death and disability in patients with lower limb artery injury caused by trauma is high. Active and orderly surgical repair according to the site and type of injury can reduce the mortality, save the function of the affected limb, and promote the healing of injury.

Cost Effectiveness of Primary Stenting in the Superficial Femoral Artery for Intermittent Claudication: Two Year Results of a Randomised Multicentre Trial

Invasive treatment of intermittent claudication (IC) is commonly performed, despite limited evidence of its cost effectiveness. IC symptoms are mainly caused by atherosclerotic lesions in the superficial femoral artery (SFA), and endovascular treatment is performed frequently. The aim of this study was to investigate its cost effectiveness vs. non-invasive treatment. One hundred patients with IC due to lesions in the SFA were randomised to treatment with primary stenting, best medical treatment (BMT) and exercise advice (stent group), or to BMT and exercise advice alone (control group). Patients were recruited at seven hospitals in Sweden. For this analysis of cost effectiveness after 24 months, 84 patients with data on quality adjusted life years (QALY; based on the EuroQol Five Dimensions EQ-5D 3L™ questionnaire) were analysed. Patient registry and imputed cost data were used for accumulated costs regarding hospitalisation and outpatient visits. The mean cost per patient was €11 060 in the stent group and €4 787 in the control group, resulting in a difference of €6 273 per patient between the groups. The difference in mean QALYs between the groups was 0.26, in favour of the stent group, which resulted in an incremental cost effectiveness ratio (ICER) of € 23 785 per QALY. The costs associated with primary stenting in the SFA for the treatment of IC were higher than for exercise advice and BMT alone. With concurrent improvement in health related quality of life, primary stenting was a cost effective treatment option according to the Swedish national guidelines (ICER < €50 000 – €70 000) and approaching the UK’s National Institute for Health and Care Excellence threshold for willingness to pay (ICER < £20 000 – £30 000). From a cost effectiveness standpoint, primary stenting of the SFA can, in many countries, be used as an adjunct to exercise training advice, but it must be considered that successful implementation of structured exercise programmes and longer follow up may alter these findings.

Clinical profile of patients with peripheral artery disease treated with high-pressure intermittent pneumatic compression in st. lukes medical center-quezon city: a 6-year retrospective cohort study

Abstract Background High-pressure intermittent pneumatic compression (HPIPC) has been proposed as an alternative intervention to supervised exercise to improve intermittent claudication in patients with peripheral artery disease (PAD). This intervention has already been introduced in the Philippines. However, no local data have been published regarding the clinical profile of patients with PAD treated with HPIPC. This study aims to determine the clinical profile of patients with PAD treated with HPIPC in our Medical Center from March 2015 to March 2021. Purpose Knowledge about the clinical profile of patients with PAD treated with HPIPC in SLMC-QC will provide local data that can lead to better planning of the next generation of PAD care in our institution or even in the Philippines. This study can therefore serve as a baseline for further studies to identify clinical outcomes using HPIPC. Methods A total of eighty-three (N=83) adult patients aged ≥19 years with confirmed diagnosis of PAD and symptoms of intermittent claudication who received at least 12 sessions of HPIPC in the Department of Vascular Medicine from March 2015 to March 2021 were included in this retrospective cohort study. The primary outcome was identification of the clinical profile of the study population that included age, sex, smoking history and co-morbidities such as hypertension, diabetes mellitus (DM), dyslipidemia, coronary artery disease (CAD) and chronic kidney disease (CKD). The secondary outcome was description of the clinical outcomes of the study population after a minimum of 12 sessions of HPIPC. Descriptive statistics were generated for all variables. Continuous variables were presented as mean (standard deviation, SD)'. Nominal and ordinal data were reported as frequencies and percentages. All data were analyzed using Statistical Package for the Social Sciences (SPSS) v27 software. The flow diagram of the study is shown in Figure 1. Results The mean (SD)' age of the study population was 75 (14)' years. Approximately 76% of them were aged ≥65 years. Overall, there were more males (57%) than females (43%) in the study. Majority of the study population were never-smokers (70%), had hypertension (89%), DM (81%), dyslipidemia (78%) and abnormal ankle-brachial index (ABI, 80%). The mean (SD)' ABI of the study population was 0.92 (0.5)'. 92% had hemodynamically significant stenosis in the distal arterial segments of the lower extremities while 62% had hemodynamically significant stenosis in the proximal arterial segments of the lower extremities (Table 1). Conclusion Age ≥65 years, male sex, never-smoker, hypertension, DM and dyslipidemia defined the clinical profile of patients with PAD treated with HPIPC in SLMC-QC from March 2015 to March 2021. Appropriate management of these risk factors can lead to better PAD care in the institution. Further studies are recommended to determine the efficacy of HPIPC in the treatment of PAD. Funding Acknowledgement Type of funding sources: None. Figure 1. Flow diagram of the studyTable 1. Results of the study

Powody, dla których warto stosować cilostazol

Occlusive atherosclerosis of the lower limbs in the initial stage is characterized by symptoms of intermittent claudication with a variable distance depending on the severity of its changes. As a progressive disease, it may lead to the obstruction of the arteries of the lower extremities and the formation of a collateral circulation network in the form of natural by-passes of obstructed sections of the arteries. Disease development is accelerated by: older age, male sex, smoking, diabetes, dyslipidemic disorders and arterial hypertension. One of the effective forms of treatment of chronic lower limb ischemia in the course of atherosclerosis is pharmacotherapy with cilostazol.

Determination of Genotoxic Azide Impurity in Cilostazol API by Ion Chromatography with Matrix Elimination

Cilostazol is a commonly used active pharmaceutical ingredient (API) to treat and reduce the symptoms of intermittent claudication in peripheral vascular disease. Recently, it was found to be a potential medicine in the effective treatment of COVID-19. In addition to the positive effects of this API, genotoxic sodium azide is used in the synthesis of cilostazol that can appear in the API. In this work, a method was developed for the determination of sodium azide (as azide anion) in cilostazol API at 7.5 ppm limit level by using ion chromatography (IC) and liquid–liquid extraction (LLE) sample preparation. The liquid–liquid extraction allows the application of high sample concentrations. Because of the low limit concentration (7.5 ppm), 500 mg sample was dissolved in 5 mL solvent. By using LLE for sample preparation, the huge amount of cilostazol was omitted and column overload was avoided. The developed method was validated in accordance with the relevant guidelines. Specificity, accuracy, precision, limit of detection and limit of quantification parameters were evaluated. The calculated limit of detection was 0.52 ppm (S/N:3) and the limit of quantification was 1.73 ppm (S/N:10) for sodium azide. The recovery of the sodium azide was 102.4% and the prepared solutions were stable in the sample holder for 24 h.

Editor's Choice – Cost Effectiveness of Primary Stenting in the Superficial Femoral Artery for Intermittent Claudication: Two Year Results of a Randomised Multicentre Trial

Invasive treatment of intermittent claudication (IC) is commonly performed, despite limited evidence of its cost effectiveness. IC symptoms are mainly caused by atherosclerotic lesions in the superficial femoral artery (SFA), and endovascular treatment is performed frequently. The aim of this study was to investigate its cost effectiveness vs. non-invasive treatment. One hundred patients with IC due to lesions in the SFA were randomised to treatment with primary stenting, best medical treatment (BMT) and exercise advice (stent group), or to BMT and exercise advice alone (control group). Patients were recruited at seven hospitals in Sweden. For this analysis of cost effectiveness after 24 months, 84 patients with data on quality adjusted life years (QALY; based on the EuroQol Five Dimensions EQ-5D 3L™ questionnaire) were analysed. Patient registry and imputed cost data were used for accumulated costs regarding hospitalisation and outpatient visits. The mean cost per patient was €11 060 in the stent group and €4 787 in the control group, resulting in a difference of €6 273 per patient between the groups. The difference in mean QALYs between the groups was 0.26, in favour of the stent group, which resulted in an incremental cost effectiveness ratio (ICER) of € 23 785 per QALY. The costs associated with primary stenting in the SFA for the treatment of IC were higher than for exercise advice and BMT alone. With concurrent improvement in health related quality of life, primary stenting was a cost effective treatment option according to the Swedish national guidelines (ICER < €50 000 - €70 000) and approaching the UK's National Institute for Health and Care Excellence threshold for willingness to pay (ICER < £20 000 - £30 000). From a cost effectiveness standpoint, primary stenting of the SFA can, in many countries, be used as an adjunct to exercise training advice, but it must be considered that successful implementation of structured exercise programmes and longer follow up may alter these findings.

Current Status of Traditional Chinese and Western Medicine Treatment of Diabetic Peripheral Vascular Disease

Diabetic peripheral vascular disease (PVD) is one of the common chronic complications of diabetes. The main clinical manifestations of PVD are numbness and coldness of the limbs, resting pain, intermittent claudication, and other symptoms. The combined treatment involving Chinese and Western medicine for PVD has various clinical methods and definite curative effects. It is worthy of in-depth clinical research and application.