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A diabetic patient with a leg ulcer
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
Usually patients with PVD present de novo with intermittent claudication, and the majority do not have diabetes. The combination carries a much worse prognosis. Up to 70% of cases may stabilise with conservative management. Claudication is also a symptom of generalised atherosclerosis, and has wider important implications for the patient. Forty per cent of non-diabetic patients who present with intermittent claudication will be dead within 5 years from the associated complications of vascular disease (myocardial infarction, stroke etc) unless preventative treatment is started. The risks are greater in those with PVD and diabetes. It must be remembered that in the UK, there are as many undiagnosed diabetics as those who are already known to have the disease. It is therefore prudent to test the serum glucose levels of all new patients presenting with intermittent claudication. Additionally, smoking is a major risk factor for the development of claudication. If patients continue to smoke having developed this symptom, the prognosis is worse.
Peripheral Vascular Disease
Published in Andrew Stevens, James Raftery, Jonathan Mant, Sue Simpson, Health Care Needs Assessment, 2018
As the underlying pathology of peripheral arterial disease and coronary heart disease are the same, it is not surprising that the aetiological risk factors for the two conditions are similar.3 The classic cardiovascular risk factors of cigarette smoking, hypercholesterolaemia and hypertension are implicated in peripheral arterial disease. Likewise, more recently investigated risk factors for coronary heart disease, such as lack of physical exercise, alcohol consumption, diabetes mellitus, low high density lipoprotein (HDL) cholesterol, hyperhomocysteinaemia, thrombophilia and hypercoagulable states, are also associated with an increased risk of peripheral arterial disease.4 Cigarette smoking would appear to be a more important risk factor for peripheral arterial disease than coronary heart disease, with over 90% of patients with intermittent claudication stating that they are current or ex-smokers.5 Diabetes mellitus is often believed to be a more important risk factor for peripheral arterial disease than coronary heart disease but the evidence for this is inconsistent. There is no doubt that diabetes mellitus is very important in the later stages of peripheral arterial disease in which diabetic neuropathy and small vessel disease, as well as atherosclerosis in large vessels, may cause gangrene and ulceration.6
Claudication and peripheral vascular disease
Published in Clive Handler, Gerry Coghlan, Nick Brown, Management of Cardiac Problems in Primary Care, 2018
Clive Handler, Gerry Coghlan, Nick Brown
Claudication is described as pain in the calf, buttock or foot, or tightness or cramp on walking that is relieved promptly by rest and worsens with exercise. It does not get better with continued walking. It is present in 15–40% of patients with peripheral vascular disease. Patients may experience cold feet and calf cramp at night, which is relieved by hanging the leg out of the bed.
The FlowOx device for the treatment of peripheral artery disease: current status and future prospects
Published in Expert Review of Medical Devices, 2021
In a recent randomized controlled trial of 72 patients with intermittent claudication, we showed that treatment with FlowOx for 1 hour twice daily for 12 weeks increased pain-free walking distance compared with sham treatment [16]. For the patients with the most symptomatic disease, there was an increase in both pain-free and maximal walking distance. This was the first double-blind, randomized sham-controlled trial to show that INP treatment increases walking capacity in patients with intermittent claudication, and the first randomized controlled trial that documented the clinical effects of FlowOx treatment. In patients with intermittent claudication, cardiovascular prevention and exercise therapy are the first-line treatment. Participation in supervised exercise therapy (SET) programs has positive effects on leg symptoms, general health, and cardiovascular risk. However, the use of SET in the management of patients with intermittent claudication is limited by low accessibility and poor compliance. A systematic review from 2016 concluded that only one third of the patients with PAD were suitable for and willing to undertake SET [17]. Hence, treatment with FlowOx might be a relevant adjunct to standard care for patients with intermittent claudication. Especially for patients with disabling claudication and a high risk of complications from endovascular or open surgical treatment, FlowOx treatment seems to be a reasonable alternative.
The randomised Oslo study of renal denervation vs. Antihypertensive drug adjustments: efficacy and safety through 7 years of follow-up
Published in Blood Pressure, 2021
Ola Undrum Bergland, Camilla Lund Søraas, Anne Cecilie K. Larstorp, Lene V. Halvorsen, Ulla Hjørnholm, Pavel Hoffman, Aud Høieggen, Fadl Elmula M. Fadl Elmula
Seven patients in the Drug Adjustment group experienced adverse events and received appropriate treatment. These events were unrelated to study participation. The first patient experienced a fall accident with only minor head trauma approximately 2 years after randomisation, causing sequelae of chronic tiredness. The same patient died from complications of emphysema 7 years after randomisation. The second patient was diagnosed with claudication. The third and fourth patients were diagnosed with benign prostate hyperplasia, while one of them was additionally found to have sleep apnoea. The fifth patient was diagnosed with primary hyperaldosteronism (without Conn adenoma) approximately 1 year after randomisation, and was treated with an aldosterone antagonist. The last two patients were diagnosed with atrial fibrillation.
Current and emerging drug treatment strategies for peripheral arterial disease
Published in Expert Opinion on Pharmacotherapy, 2020
Hani Essa, Francesco Torella, Gregory Y. H. Lip
PAD symptomology often falls into 3 clinical patterns [14]: Classic intermittent claudication is thought to affect 10–30% of people. This is characterized by exertional discomfort in one or both legs, which occurs with exercise and is relieved by with rest. The site of the pain can often indicate the location of the disease. Atypical leg pains affect 20–40% of patients. The largest cohort of 50% are thought to be asymptomatic [15]. The mortality risk of patients presenting with intermittent claudication is double that of asymptomatic patients [16]. There are multiple classification systems for these patterns of symptoms in chronic PAD [17]. The two most utilized are the 1954 Fontaine [18] and the 1986 Rutherford classification [19] and its 1997 revision [20]. Both have been utilized widely in clinical settings to direct patient management and for research purposes. The Fontaine classification is solely based on clinical symptoms, without other diagnostic tests. The Rutherford classification is more detailed and describes acute and chronic limb ischemia separately. It also associates clinical symptoms with objective findings – ankle-brachial index (ABI), pulse volume recordings, and vascular Doppler ultrasound. The Rutherford classification for chronic limb ischemia can be viewed in Table 1.