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.

Keywords

buttocks claudication diagnosis pain peripheral arterial disease

References

Gray JC. Diagnosis of intermittent vascular claudication in a patient with a diagnosis of sciatica. Phys Ther 1999; 79: 582-590.

Smith G , Train J , Mitty H , Jacobson J. Hippain caused by buttock claudication. Relief of symptoms by transluminal angioplasty. Clin Orthop 1992; Nov (284): 176-180.

Byrne P , Provan JL , Ameli FM , Jones DP. The use of transcutaneous oxygen tension measurements in the diagnosis of peripheral vascular insufficiency. Ann Surg 1984; 200: 159-165.

Christensen KS , Larsen JF , Klaerke M. Transcutaneous oxygen tension response to exercise in health and in occlusive arterial disease. Acta Chir Scand 1986; 152: 657-660.

Caillard P , Mouren X , Bailliart O , Cloarec M. Evaluation of ifenprodil efficacy on exercise-induced tissue ischemia in stage II arteriopathy by measurement of transcutaneous oxygen tension during a standard tread-mill test: double-blind study of injectable ifenprodil versus placebo. Angiology 1993; 44: 552-560.

Abraham P , Picquet J , Vielle B et al. Transcutaneous oxygen pressure measurements on the buttocks during exercise to detect proximal arterial ischemia: comparison with arteriography. Circulation 2003; 107: 1896-1900.

Abraham P , Picquet J , Vielle B , L’Hoste P , Enon B , Saumet J-L. Transcutaneous oxygen pressure measurements (tcpO2) at the ankle during exercise in arterial claudication. Int Angiol 2004; 23 (S1) 54-54.

Bouye P , Picquet J , Jacquinandi V et al. Reproducibility of proximal and distal transcutaneous oxygen pressure measurements during exercise in stage 2 arterial claudication. Int Angiol 2004; (in press).

Criqui MH , Denenberg JO , Bird CE , Fronek A , Klauber MR , Langer RD. The correlation between symptoms and non-invasive test results in patients referred for peripheral arterial disease testing. Vasc Med 1996; 1: 65-71.

10.

Rose GA. The diagnosis of ischaemic heart pain and intermittent claudication in field surveys. Bull World Health Organ 1962; 27: 645-658.

11.

Fowkes FG , Housley E , Cawood EH , Macintyre CC , Ruckley CV , Prescott RJ. Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. Int J Epidemiol 1991; 20: 384-392.

12.

Lacroix P , Aboyans V , Boissier C , Bressollette L , Leger P.

[Validation of a French translation of the Edinburgh claudication questionnaire among general practitioners’ patients.]

Arch Mal Coeur Vaiss 2002; 95: 596-600.

13.

Leng GC , Fowkes FG. The Edinburgh Claudication Questionnaire: an improved version of the WHO=Rose Questionnaire for use in epidemio-logical surveys. J Clin Epidemiol 1992; 45: 1101-1109.

14.

Chong PF , Garratt AM , Golledge J , Greenhalgh RM , Davies AH. The intermittent claudication questionnaire: a patient-assessed condition-specific health outcome measure. J Vasc Surg 2002; 36: 764-771; discussion 863-64.

15.

Spengel F , Clement D , Boccalon H , Liard F , Brown T , Lehert P. Findings of the Naftidrofuryl in Quality of Life (NIQOL) European study program. Int Angiol 2002; 21: 20-27.

16.

Mehta T , Venkata Subramaniam A , Chetter I , McCollum P. Disease-specific quality of life assessment in intermittent claudication: review. Eur J Vasc Endovasc Surg 2003; 25: 202-208.

17.

Sugano N , Inoue Y , Iwai T. Evaluation of buttock claudication with hypogastric artery stump pressure measurement and near infrared spectroscopy after abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 2003; 26: 45-51.

18.

Kritpracha B , Pigott JP , Price CI , Russell TE , Corbey MJ , Beebe HG. Distal internal iliac artery embolization: a procedure to avoid. JVasc Surg 2003; 37: 943-948.

19.

Karch LA , Hodgson KJ , Mattos MA , Bohannon WT , Ramsey DE , McLafferty RB. Adverse consequences of internal iliac artery occlusion during endovascular repair of abdominal aortic aneurysms. J Vasc Surg 2000; 32: 676-683.

20.

Mehta M , Veith FJ , Ohki T etal. Unilateral and bilateral hypogastric artery interruption during aortoiliac aneurysm repair in 154 patients: a relatively innocuous procedure. J Vasc Surg 2001; 33: S27-S32.

21.

Arko FR , Lee WA , Hill BB , Fogarty TJ , Zarins CK. Hypogastric artery bypass to preserve pelvic circulation: improved outcome after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2004; 39: 404-408.

22.

Wyers MC , Schermerhorn ML , Fillinger MF et al. Internal iliac occlusion without coil embolization during endovascular abdominal aortic aneurysm repair. J Vasc Surg 2002; 36: 1138-1145.

23.

Lin PH , Bush RL , Chaikof EL et al. A prospective evaluation of hypogastric artery embolization in endovascular aortoiliac aneurysm repair. J Vasc Surg 2002; 36: 500-506.

24.

Bruninx G , Salame H , Wery D , Delcour C.

[Doppler study of gluteal arteries. A useful tool for excluding gluteal arterial pathology and an important adjunct to lower limb Doppler studies.]

J Mal Vasc 2002; 27: 12-17.

25.

Fukui D , Urayama H , Tanaka K , Kawasaki S. Use of near-infrared spectroscopic measurement at the buttocks during abdominal aortic surgery. Circ J 2002; 66: 1128-1131.

26.

Comerota AJ , Throm RC , Kelly P , Jaff M. Tissue (muscle) oxygen saturation (StO2): a new measure of symptomatic lower-extremity arterial disease. J Vasc Surg 2003; 38: 724-729.

27.

Lyden SP , Sternbach Y , Waldman DL , Green RM. Clinical implications of internal iliac artery embolization in endovascular repair of aortoiliac aneurysms. Ann Vasc Surg 2001; 15: 539-543.

28.

Yano OJ , Morrissey N , Eisen L et al. Intentional internal iliac artery occlusion to facilitate endovascular repair of aortoiliac aneurysms. J Vasc Surg 2001; 34: 204-211.

29.

Pittaluga P , Batt M , Hassen-Khodja R , Declemy S , Le Bas P. Revascularization of internal iliac arteries during aortoiliac surgery: a multicenter study. Ann Vasc Surg 1998; 12: 537-543.

30.

Jensen J , Lendorf A , Stimpel H , Frost J , Ibsen H , Rosenkilde P. The prevalence and etiology of impotence in 101 male hypertensive outpatients. Am J Hypertens 1999; 12: 271-275.