CONSERVATIVE MANAGEMENT IN INTERMITTENT C LAUDICATION - A REVIEW

The management of intermittent claudication involves diagnostic evalua tion of the extent of arteriosclerosis in different vascular areas, ca rdiac risk, other important diseases and indications for interventiona l procedures in diseased vessels. Nonmedical therapeutic measures invo lve control of major contributing risk factors, e.g. smoking, arterial hypertonia, hypercholesteremia and metabolic syndrome. Resting blood now to skeletal muscles is low. Therefore, exercise is important in ad dition to all therapeutic measures because it increases blood Bow and thereby causes endogenous vasodilatation and improves performance, Med ical therapy should be focused on underlying diseases, risk factors an d on peripheral blood now, Vasodilators are generally useful, however, arteriolar vasodilation seems to be more beneficious than a more veno us site of action like in nitrates or alpha-blockers. Increased sympat hetic activity may impair collateral blood now despite effective vasod ilatation like in nifedipine, Data on calcium-antagonists are not cons istent, however, selective dihydropyridines like felodipine increase c ollateral blood now, Ace-inhibitors are beneficial after at least 10 w eeks of therapy, possibly by cardiac action and effects on (collateral ) endothelic function, Peripheral vasodilatators like pentoxifylline o r i.v. prostaglandins are only useful if severe peripheral now problem s exist, Cardiac function is important for maintaining blood now to th e stenosis and is improved by ace-inhibitors, beta-blockers and antihy pertensive medication, Beta-adrenergic blockers have no negative effec ts on performance and decrease cardiac risk, Transstenotic blood now i s dependent on blood fluidity which is influenced by hematocrit, pento xifylline, felodipine and exercise. Diuretics should be used cautiousl y, Patients should receive low dose aspirin. LDL-cholesterol should be lowered to 100 mg/dl, this improves endothelic function, decreases co mplaints and may cause regression of arteriosclerosis.