Pain description in patients with isolated proximal (without distal) exercise-related lower limb arterial ischemia

Abstract

Among the last 250 claudicants referred to the laboratory for transcutaneous oxygen pressure recording at exercise, we analyzed the symptoms reported by the 36 patients who showed isolated proximal (without distal) ischemia. Among the symptomatic proximal sites cited by these patients, the hip and thigh represent 60%, whereas the buttock is cited in fewer than 25% of cases. Buttock symptoms are reported in only 31% of symptomatic patients. 'Buttock' claudication is probably not the dominant symptom in isolated proximal vascular ischemia. Assessing proximal lower limb ischemia through the sole detection of 'buttock pain' could contribute to the underestimation of proximal vascular ischemia.

Exercise treadmill testing in patients with claudication, with and without diabetes

“…During the test, subjects were repeatedly asked about the presence, location and severity of symptoms in their limbs and about non‐limb symptoms. Immediately after the end of the walking period, they completed a French translation of the San Diego Claudication Questionnaire (SDCQ) [11]. Only exercise‐related symptoms that were absent at rest, occurred during exercise and disappeared within 10 min after exercise (i.e.…”

Simultaneous pain intensity rating and quantification of ischemia throughout exercise and recovery in proximal versus distal arterial claudication

“…First, in the so-called 'Leriche syndrome' (occlusion of the terminal aorta and proximal ischemia), pain is usually described as a lower limb fatigability, whereas calf (Rose-type) claudication is described as a cramp or pain. 6 Second, exerciseinduced proximal claudication seems to be under-reported by patients and under-diagnosed by clinicians 7,8 compared to distal claudication. It has never been studied whether these differences rely on a difference in the relationship between exercise-induced proximal/distal ischemia or a different perception of proximal/distal pain intensity.…”

Heart rate recovery after constant-load exercise tests is decreased in proportion to the importance (severity and diffusion) of exercise-induced lower-limb ischaemia

“…, 2003, 2005; Bouye et al. , 2004) and may allow for the recording of regional blood flow impairment on both limbs and at both proximal and distal levels simultaneously (Jacquinandi et al. , 2004).…”

“…In peripheral artery disease (PAD), HRR1 could be decreased as a function of the ÔimportanceÕ of lower-limb ischaemia, which means not only as a function of the local severity of exerciseinduced muscle ischaemia in the lower limbs, but also as a function of the regional diffusion of ischaemia (quantity of muscle mass affected by ischaemia). Changes in transcutaneous oxygen pressure (TcpO2) during exercise are proportional to the local severity of arterial lesions (Abraham et al, 2003(Abraham et al, , 2005Bouye et al, 2004) and may allow for the recording of regional blood flow impairment on both limbs and at both proximal and distal levels simultaneously (Jacquinandi et al, 2004). As such, exercise TcpO2, although a time-consuming and not a primary care technique, is a unique research tool to estimate not only the local severity but also the regional diffusion of ischaemia during exercise.…”