Abstract
The prevalence of intermittent claudication (IC) increases with age; when questioned, older patients consider increased difficulty in walking to be a normal consequence of aging. Although the prognosis for the involved limb with IC is relatively good, IC is an important clinical predictor of increased cardiovascular mortality. It is important to effect a minimal strategy for determining the presence of lesions in different vascular regions: carotids, coronaries, aorta and renal arteries. The goals for the treatment of IC in the elderly are to improve the walking distance and quality of life and to increase survival.
Practical guidelines for the treatment of IC are to first establish a correct diagnosis. Then, patients have to apply life-style modifications and participate in an exercise programme, with the next treatment step involving the use of anti-platelet drugs. However, it must be remembered that older patients could have limitations on exercise; in such cases, a vasoactive drug should be considered. The third guideline consists of multifocal evaluation of the arteries, specifically the coronaries, carotids and abdominal aorta.
The existence of an iliac obstruction or stenosis requires consideration of the 2 last guidelines. In more than 75% of cases, elderly patients have femoropopliteal or distal arterial obstructions: exercise and a vasoactive drug should be employed in these instances. The presence of iliac lesions has to be discussed in the presence of a multidisciplinary team in a vascular centre, and should consider the usefulness of percutaneous transluminal angioplasty or surgery.
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References
Caspary L. Epidemiology of vascular disease. Dis Manage Health Outcomes 1997; 2Suppl. 1: 9–17
Taylor LM, Porter JM. Natural history and nonoperative treatment of chronic lower extremity ischemia. In: Rutherford RB, editor. Vascular surgery. 3rd ed. Philadelphia (PA): WB Saunders, 1989; 653–67
Radack K, Wyderski RJ. Conservative management of intermittent claudication. Ann Intern Med 1990; 113: 135–46
Bowlin SJ, Medalie JH, Flocke SA, et al. Intermittent claudication in 8343 men and 21-year specific mortality follow-up. Ann Epidemiol 1997; 7: 180–7
Bevan EG, Waller PC, Ramsay LE. Pharmacological approaches to the treatment of intermittent claudication. Drugs Aging 1992; 2(2): 125–36
Coffman JD. Intermittent claudication: not so benign. Am Heart J 1986; 112(5): 1127–8
Curb JD, Masaki K, Rodriguez BL, et al. Peripheral arterial disease and cardiovascular risk factors in the elderly: the Honolulu Heart Program. Arterioscler Thromb Vasc Biol 1996; 12: 1495–500
Leng GC, Fowkes FGR, Lee AT, et al. Use of the ankle brachial pressure index to predict cardiovascular events and deaths: a cohort study. BMJ 1996; 313: 1440–4
Spittell JA. Diagnosis and management of occlusive peripheral arterial disease. Curr Probl Cardiol 1990: 7–35
McDaniel MD, Cronenwett JL. Basic data related to the natural history of intermittent claudication. Ann Vasc Surg 1989; 3: 273–7
Scott RAP, Wilson NM, Asthton HA, et al. Influence of screening on the incidence of ruptured abdominal aortic aneurysm: 5-year results of a randomized controlled study. Br J Surg 1995; 82: 1066–70
Gersh BJ, Rihal CS, Rooke TW, et al. Evaluation and management of patients with both peripheral vascular and coronary artery disease. J Am Coll Cardiol 1991; 18: 203–14
Boccalon H. Diagnosis of vascular disease and treatment outcome disease. Dis Manage Health Outcomes 1997; 2Suppl. 1: 47–9
Freund KM, Belanger AJ, D’agostino RB, et al. The health risks of smoking: the Framingham study: 34 years of follow-up. Ann Epidemiol 1993; 3: 417–24
Gardner AW, Poehlman ET. Exercise rehabilitation programs for the treatment of claudication pain: a meta-analysis. JAMA 1995; 27: 975–80
Ernst E, Fialka V. A review of the clinical effectiveness of exercise therapy for intermittent claudication. Arch Intern Med 1993; 153: 2357–60
Regensteiner JG, Steiner JF, Hiatt WR. Exercise training improves functional status in patients with peripheral arterial disease. J Vasc Surg 1996; 23: 104–15
Martini J, Boccalon H, Tauber JP, et al. The diabetic foot. In: Encyclopédie Médico-Chirurgicale: Angéiologie. Paris: Elsevier, 1997; 19–0550: 6
Gray BH, Sullivan TM, Childs MB, et al. High incidence of restenosis/reocclusion of stents in the percutaneous treatment of long-segment superficial femoral artery disease after sub-optimal angioplasty. J Vasc Surg 1997; 25: 74–83
Tunis SR, Bass EB, Steinberg EP. The use of angioplasty, bypass surgery and amputation in the management of peripheral vascular disease. N Engl J Med 1991; 325(8): 556–62
Frampton JE, Brogden RN. Pentoxifylline (Oxpentifylline). A review of its therapeutic efficacy in the management of peripheral vascular and cerebrovascular disorders. Drugs Aging 1995; 7(6): 480–503
Hood SC, Moher D, Barber GG. Management of intermittent claudication with pentoxifylline: meta-analysis of randomized controlled trials. Can Med Assoc J 1996; 155(8): 1053–9
Gillings DB. Pentoxifylline and intermittent claudication: review of clinical trials and cost-effectiveness analyses. J Cardiovasc Pharmacol 1995; 25(2): S44–50
Barradell LB, Brogden RN. Oral naftidrofuryl: a review of its pharmacology and therapeutic use in the management of peripheral occlusive arterial disease. Drugs Aging 1996; 8(4): 299–322
Lehert P, Riphagen FE, Gamand S. The effect of naftidrofuryl on intermittent claudication: a meta analysis. J Cardiovasc Pharmacol 1990; 16(3): S81–86
Brevetti G, Di Lisa F, Perna S, et al. Carnitine-related alterations in patients with intermittent claudication: indication for a focused carnitine therapy. Circulation 1996; 93: 1685–9
Bergqvist D, Almgren B, Dickinson JP. Reduction of requirement for leg vascular surgery during long-term treatment of claudication patients with ticlopidine: results from the Swedish Ticlopidine Multicenter Study (STIMS). Eur J Vasc Endovasc Surg 1995; 10: 69–76
Coccheri S, Palaretti G, Fortunato G. Antithrombotic drugs in peripheral obliterative arterial diseases. Haemostasis 1994; 24: 118–27
Diener HC, Cunha L, Forbes C, et al. European Stroke Prevention Study 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci 1996; 143: 1–13
Antiplatelet Trialist’s Collaboration. Collaborative overview of randomized trials of antiplatelet therapy: 1-prevention of death, myocardial infarction and stroke by prolonged anti-platelet therapy in various categories of patients. BMJ 1994; 308: 81–106
CAPRIE Steering Committee. A randomised-blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996; 248: 1329–39
Hennekens C, Dyken ML, Fuster V. Aspirin as a therapeutic agent in cardiovascular disease: a statement for healthcare professionals from the american heart association. Circulation 1997; 96: 2751–3
Shepherd J. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995; 333: 1301–7
Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4,444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4 S). Lancet 1994; 344: 1383–9
The PPP Project Investigator. Design, rationale and baseline characteristics of the pravastatin pooling (PPP) project: a combined analysis of three large-scale randomised trials: long-term intervention with pravastatin in ischemic disease (LIPID), cholesterol and recurrent events (CARE), and west of Scotland coronary prevention study (WOSCOPS). Am J Cardiol 1995; 76: 899–905
Fonseca V, Mikhailidis DP, Barradas MA, et al. Double-blind, placebo controlled trial of buflomedil in intermittent claudication. Int J Clin Pharmacol Res 1988; 8: 377–81
Blume J, Kieser M, Holscher U. Placebo-controlled double blind study on the efficacy of gingko biloba extract Egb 761 in trained patients suffering from intermittent claudication. VASA 1996; 25(3): 265–74
Radack K, Deck C. β adrenergic blocker therapy does not worsen intermittent claudication in subjects with peripheral arterial disease. Arch Intern Med 1991; 151: 1769–76
Heintzen MP, Strauer BE. Peripheral vascular effects of beta-blockers. Eur Heart J 1994; 15Suppl. C: 2–7
Juergens JL, Pluth JR. Trauma and peripheral vascular disease. In: Juergens JL, Spitell JA Jr, Fairbairn JFII, editors. Peripheral vascular diseases. 5th ed. Philadelphia: Saunders WB Co, 1980: 607–27
Lindgärde F, Labs KH, Robner M. The pentoxifylline experience: exercise testing reconsidered. Vasc Med 1996; 1: 145–54
Langley PC, Coons SJ. Peripheral vascular disorders: a pharmacoeconomic and quality of life review. Pharmacoeconomics 1997; 3: 225–36
Arfvidsson B, Karlsson J, Dahllof AG, et al. The impact of intermittent claudication on quality of life evaluated by the Sickness Impact Profile Technique. Eur J Clin Invest 1993; 23: 741–5
Creutzig A, Bullinger M, Cachovan M, et al. Improvement in the quality of life after IV PGE1 therapy for intermittent claudication. VASA 1997; 26: 122–7
Cook TA, O’Reagan M, Galland RB. Quality of life following percutaneous transluminal angioplasty for claudication. Eur J Vasc Surg 1996; 11: 191–4
Spengel FA, Brown TM, Dietze S, et al. The claudication scale (CLAU-S): a new disease-specific quality-of-life instrument in intermittent claudication. Dis Manage Health Outcomes 1997; 2Suppl. 1: 65–70
Waller D, Chant A. Intermittent claudication. Prescriber’s J 1995; 35(2): 64–70
Hiatt WR, Creager MA, Cooke JP, et al. Building a partnership between vascular medicine and vascular surgery: a coalition for the future of vascular care. J Vasc Surg1996; 5: 918–25
Edwards P. Management of lower limb intermittent claudication: development of a care pathway. Dis Manage Health Outcomes 1997; 2Suppl. 1: 18–29
Lowe GDO. Drugs in cerebral and peripheral arterial disease. BMJ 1990; 300(24): 524–8
Pentoxifylline and naftidrofuryl: commonly used drugs for intermittent claudication. Drugs Ther Perspect 1996; 7(10): 1–5
Cameron HA, Waller PC, Ramsay LE. Drug treatment of intermittent claudication: a critical analysis of the methods and findings of published clinical trials, 1965–1985. Br J Clin Pharmacol 1988; 26: 569–76
Whyman MR, Fowkes FGR, Kerracher EMG, et al. Is intermittent claudication improved by percutaneous transluminal angioplasty? A randomized controlled trial. Br J Surg 1997; 84Suppl. 1: 1
Creasy TS, McMillan PJ, Fletcher EW, et al. Is percutaneous transluminal angioplasty better than exercise for claudication? Preliminary results from a prospective randomised trial. Eur J Vasc Surg 1990; 4: 135–40
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Boccalon, H. Intermittent Claudication in Older Patients. Drugs & Aging 14, 247–259 (1999). https://doi.org/10.2165/00002512-199914040-00002
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DOI: https://doi.org/10.2165/00002512-199914040-00002