The measured effect of stopping smoking on intermittent claudication

Quick, Clive R.G.; Cotton, L. T.

doi:10.1002/bjs.1800691309

Cited by 199 publications

(63 citation statements)

References 15 publications

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“…In one series of patients who presented with hand ischemia, Ͼ90% gave a history of smoking (current smokers 58%; former smokers 34%) (10). Smoking cessation is beneficial (57) and should be strongly encouraged in these cases.…”

Section: Management Proposal For Dhismentioning

confidence: 99%

Arteriovenous Access and Hand Pain

León

Asif

2007

Clinical Journal of the American Society of Nephrology

125

104

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An ischemic hand in a hemodialysis patient is a serious condition. It causes significant pain and discomfort but also can lead to tissue necrosis and the eventual loss of digits and even the entire hand. Although stealing of blood away from the high-resistance forearm arteries into the low-resistance arteriovenous access generally is assumed to be the cause, a great majority of both wrist and elbow accesses demonstrate retrograde flow without any evidence of hand pain or ischemia. Consequently, demonstration of retrograde flow alone does not predict or indicate the existence of distal ischemia. In this context, the term "arterial steal syndrome" is a misnomer to indicate the presence of peripheral ischemia. Recent studies have shown that, in many cases, arterial stenotic lesions cause distal hypoperfusion and result in hand ischemia. In other cases, distal arteriopathy as a result of generalized vascular calcification and diabetes is the culprit. Because any or a combination of the three mechanisms (retrograde flow, stenotic lesions, and distal arteriopathy) can lead to peripheral ischemia, distal hypoperfusion ischemic syndrome is a more appropriate term to denote hand ischemia. Treatment should start with a detailed history and physical examination to help rule out other (nonischemic) causes of hand pain. A complete arteriogram to evaluate the circulation of the extremity from the aortic arch to the palmar arch is essential. The choice of treatment modality and procedure to apply should be based on this evaluation. This report reviews the pathophysiology and presents current strategies to ameliorate distal hypoperfusion ischemic syndrome.

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Section: Management Proposal For Dhismentioning

confidence: 99%

Arteriovenous Access and Hand Pain

León

Asif

2007

Clinical Journal of the American Society of Nephrology

125

104

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“…Regular exercise (Ekroth et al, 1978;Clifford et al, 1980) and stopping smoking (Quick & Cotton, 1982) may improve symptoms of claudication, and the latter also benefits associated coronary artery or cerebrovascular disease (Hughson et al, 1978), which are the main determinants of prognosis in patients with peripheral vascular disease (Reunanen et al, 1982). It is also customary to control concomitant hypertension and diabetes, although there is no evidence that either measure improves the symptoms of intermittent claudication.…”

mentioning

confidence: 99%

Drug treatment of intermittent claudication: a critical analysis of the methods and findings of published clinical trials, 1965‐1985 [see comments]

Cameron

Waller

Ramsay

1988

Brit J Clinical Pharma

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1 All trials of drug therapy for intermittent claudication published in English during the period 1965-1985 were reviewed. A total of 75 trials had studied 33 different pharmacological agents. Treadmill exercise, the most reproducible method of evaluating symptoms in this condition, was used in 49% of trials. 2 Oxpentifylline was the drug that had been most frequently studied. In seven placebocontrolled trials the average response to oxpentifylline, compared with placebo and weighted for sample-size, was 65% improvement in claudication distance. There was, however, a significant negative relation between sample-size and response (rs = -0.79, P < 0.05), suggesting that this estimate was likely to have been biased by non-publication of negative results. 3 One third of all trials were uncontrolled; 84% of these reported benefit from drug treatment, compared with 32% of placebo-controlled trials (P < 0.001). Sample-sizes varied from seven to 227 patients; 31% of trials reported data from less than 20 patients and these were likely to have had insufficient statistical power. 4 Overall, 57 of the 75 trials (76%) had at least one of the following deficiencies: an uncontrolled design; not double-blind; failure to use treadmill exercise; less than 20 patients included in the analysis. Thus, a priori three-quarters of all trials were unlikely to have made a satisfactory assessment of drug efficacy. 5 The information available does not establish convincingly that any drug consistently improves exercise performance in intermittent claudication. In view of the deficiencies in previous trials, we propose guidelines for future studies with regard to trial design, sample-size and methods of exercise testing.

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“…Mortality rate was reduced by moderately vigorous exercise and quitting smoking by 23% and 41% respectively [15]. Risks of death, heart attack and amputations are significantly higher in patients with PAD who continue to smoke than those who are able to quit smoking [16][17][18][19]. Supervised treadmill exercise programs increased maximal treadmill walking time by 50-200% [20][21][22][23].…”

Section: Resultsmentioning

confidence: 99%

Claudication: A Teachable Moment or Missed Opportunity!

Jindeel¹

2017

Clin Med Rev Case Rep

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Claudication is a common manifestation of Peripheral Arterial Disease (PAD) and atherosclerosis. Patients with claudication are at increased risk of cardiovascular events and limb-related complications. Optimal medical therapy is effective in relieving patient's symptoms and reducing their risk of cardiovascular events.Case: A 54-year-old male with hypertension, hyperlipidemia, tobacco use and sedentary lifestyle presented with left lower extremity exertional pain. Lower extremity segmental arterial study was consistent with the presence of Lower extremity arterial disease. He was managed medically with resolution of his claudication symptoms and improvement of his segmental study. Conclusion:Medical management of patients with claudication is extremely effective and should be provided to all patients with claudication, even those who undergo revascularization to reduce their risk of cardiovascular events, improve their claudication symptoms and general health.

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The measured effect of stopping smoking on intermittent claudication

Cited by 199 publications

References 15 publications

Arteriovenous Access and Hand Pain

Arteriovenous Access and Hand Pain

Drug treatment of intermittent claudication: a critical analysis of the methods and findings of published clinical trials, 1965‐1985 [see comments]

Claudication: A Teachable Moment or Missed Opportunity!

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