The Trials and Tribulations of Pentoxifylline

Abstract

The syndrome of intermittent claudication is the most common reason a patient with atherosclerosis of the abdominal aorta, its iliac branches or leg arteries, presents for an opinion about therapy. The prevalence of this syndrome is approximately 1.5% to 6% in menl2 and slightly less than 2% in women.3 The Framingham study data suggest a 2:1 male-female ratio at presentation.' The rate of presentation increases with age up to 75 years, after which the incidence rate levels off.Intermittent claudication has a favorable prognosis in terms of limb salvage. Only 5% to 6% of the claudicant population progress to ischemia severe enough to require amputation within 5 years of presentation.5-' Claudication is, however, an important predictor of the presence of atherosclerosis in other vascular beds. It is a marker of increased cardiovascular mortality.8-10 Despite the increased mortality ratios for both men and women, 70% to 80% of claudicants survive 5 years, 40% survive 10 years, and 26% are still alive 15 years after first presentations. 11,12 The diagnosis of atherosclerotic involvement of the lower extremity can be made with great accuracy on clinical grounds. 13 The features of pain, heaviness, and tiredness or fatigue in the muscles of the lower extremity brought on by walking, relieved by rest, and occurring again after walking the same distance are the key elements in the history. The claudication distance is an accurate indicator of the severity of the problem and is indicative of the number of levels of the arterial tree that are involved. Physical examination reveals the absence of pulses or their quality when present. The sites of flow disturbance may be detected by the presence of a bruit along the vessel. The state of the skin is an accurate reflection of nutritive blood flow in patients with more advanced atherosclerosis.The simple o~ce test of Doppler-derived ankle blood pressures allows quantification by means of the ankle / brachial systolic pressure index and excludes almost all cases of pseudoclaudication.