The site of the Media Sphera Publishers contains materials intended solely for healthcare professionals.
By closing this message, you confirm that you are a certified medical professional or a student of a medical educational institution.

Login
EN
+7 (495) 482-4118
+7 (495) 482-0604
+8 800 250-18-12
  • (toll-free number for subscriptions)
    Mon-Fri from 10 a.m. to 6 p.m.

  • © 1998-2025
+7 (495) 482-43-29
EN
All journals
Journal
Year
Year
Search result: 0

Shabunin A.V.

S.P. Botkin City Clinical Hospital, Moscow, Russia;
Russian Medical Academy of Continuous Professional Education, Ministry of Health of the Russian Federation, Moscow, Russia

Matveev D.V.

Kafedra gospital'noĭ khirurgii GBOU DPO RMAPO Minzdrava Rossii

Kuznetsov M.R.

Pirogov Russian National Research Medical University, Moscow, Russia

Matveev A.D.

Russian Medical Academy of Postgraduate Education, Moscow, Russia

Conservative treatment of chronic lower limb ischemia in ambulatory practice

Authors:

Shabunin A.V., Matveev D.V., Kuznetsov M.R., Matveev A.D.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2019;(3): 98‑104

DOI: 10.17116/hirurgia201903198

Read: 20857 times

Download PDF (RU)
Contact the author
Table of contents

CONSERVATIVE TREATMENT OF CHRONIC LOWER LIMB ISCHEMIA IN AMBULATORY PRACTICE
CONSERVATIVE TREATMENT OF CHRONIC LOWER LIMB ISCHEMIA IN AMBULATORY PRACTICE

To cite this article:

Shabunin AV, Matveev DV, Kuznetsov MR, Matveev AD. Conservative treatment of chronic lower limb ischemia in ambulatory practice. Pirogov Russian Journal of Surgery. 2019;(3):98‑104. (In Russ.)
https://doi.org/10.17116/hirurgia201903198

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)
МСФ на ЯМ
Использование инфографики авторами научных работ
Close metadata
Recommended articles:
Modern approaches in endo­vascular and endo­scopic treatment of isolated sple­nic injury. Piro­gov Russian Journal of Surgery. 2024;(12):5-12
Risk factors asso­ciated with myopic macu­lopathy in acquired myopia. Russian Annals of Ophthalmology. 2024;(5):35-45
Rationale for the use of non-linear statistical methods in the analysis of rela­tionships between risk factors and fatal events acco­rding to the data of long-term prospective obse­rvation in popu­lation of Russia and the United States of America. Russian Journal of Preventive Medi­cine. 2024;(11):34-39
Features of como­rbidity pathology in young people. Russian Journal of Preventive Medi­cine. 2024;(11):63-69
Comparison of models for prediction of spontaneous preterm birth. Medi­cal Technologies. Asse­ssment and Choice. 2024;(4):10-19
Stru­ctural and functional features of the main arte­ries of the brain and tumor necrosis factor-alpha in people with chro­nic non-infectious diseases. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(11):178-184
Conservative treatment for avascular necrosis of the femo­ral head: a systematic review. Rege­nerative Biotechnologies, Preventive, Digi­tal and Predictive Medi­cine. 2024;(4):52-67
Gastric cancer: inci­dence, risk factors, screening. Russian Journal of Preventive Medi­cine. 2024;(12):135-139
Physical medi­cal reha­bilitation of patients with dystrophinopathies: dyna­mics of the disease’s course considering clinical anthropometric indi­cators. Problems of Balneology, Physiotherapy and Exercise Therapy. 2024;(6):31-39
Effect of Sulo­dexide on Endo­thelial Function and Quality of Life in Patients with Vari­cose Veins. Journal of Venous Diso­rders. 2024;(4):308-316
Abstract:

Peripheral artery disease is still one of the most important surgical problems. General surgeons treat the majority of patients with chronic lower limb ischemia due to the lack of specialized surgical care. Current methods for risk factors adjustment, exercise therapy and the most common drugs for intermittent claudication management are reviewed in the article. The effect of these medicines on subjective (pain-free walking distance, maximal walking distance, etc.) and objective (ankle-brachial index) parameters and the incidence of complications are analyzed.

Keywords:

chronic lower limb ischemia
intermittent claudication
conservative treatment
risk factors
exercise therapy
pentoxifylline
cilostazol
aspirin
clopidogrel
naftidrofuryl
prostaglandins
propionyl-L-carnitine
actovegin
sulodexide
VEGF165
neovasculgen

Authors:

Shabunin A.V.

S.P. Botkin City Clinical Hospital, Moscow, Russia;
Russian Medical Academy of Continuous Professional Education, Ministry of Health of the Russian Federation, Moscow, Russia

Matveev D.V.

Kafedra gospital'noĭ khirurgii GBOU DPO RMAPO Minzdrava Rossii

Kuznetsov M.R.

Pirogov Russian National Research Medical University, Moscow, Russia

Matveev A.D.

Russian Medical Academy of Postgraduate Education, Moscow, Russia

Close metadata

References:

  1. Aboyans V, Ricco JB, Marie-Louise EL, Bjorck M, Brodmann M, Cohnert T, Collet JP, Czerny M, De Carlo M, Debus S, Espinola-Klein C, Kahan T, Kownator S , Mazzolai LA, Ross Naylor, Roffi M, Rother J, Sprynger M, Tendera M, Tepe G, Venermo M, Vlachopoulos C, Desormais I. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). European Heart Journal. 2018 March;39(9):763-816. https://doi.org/10.1016/j.rec.2017.12.014
  2. Fatmata B, Steve S. Bhimji. Peripheral Arterial Disease Upstate Medical University Last Update: February 7, 2017. https://www.ncbi.nlm.nih.gov/books/NBK430745/
  3. Willigendael EM, Teijink JA, Bartelink ML, Peters RJ, Büller HR, Prins MH. Smoking and the patency of lower extremity bypass grafts: a metaanalysis. J Vasc Surg. 2005;42:67-74. https://doi.org/10.1016/j.jvs.2005.03.024
  4. Aiello FA, Khan AA, Meltzer AJ, Gallagher KA, McKinsey JF, Schneider DB. Statin therapy is associated with superior clinical outcomes after endovascular treatment of critical limb ischemia. J Vasc Surg. 2012;55:371-379. https://doi.org/10.1016/j.jvs.2011.08.044
  5. Aung PP, Maxwell HG, Jepson RG, Price JF, Leng GC. Lipid-lowering for peripheral arterial disease of the lower limb. Cochrane Database Syst Rev. 2007;4. https://doi.org/10.1002/14651858.CD000123.pub2
  6. Momsen AH, Jensen MB, Norager CB, Madsen MR, Vestersgaard-Andersen T, Lindholt JS. Drug therapy for improving walking distance in intermittent claudication: a systematic review and metaanalysis of robust randomised controlled studies. Eur J Vasc Endovasc Surg. 2009;38:463-474. https://doi.org/10.1016/j.ejvs.2009.06.002
  7. Anthenelli RM, Benowitz NL, West R, St Aubin L, McRae T, Lawrence D, et al. Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial. Lancet. 2016;387:2507-2520. https://doi.org/10.1016/S0140-6736(16)30272-0
  8. Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Porriere MA, Drachman DE, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease. Circulation. 2017;135:e726-e779. https://doi.org/10.1161/CIR.0000000000000471
  9. Dias RM, Forjaz CL, de M, Cucato GG, Costa LAR, Câmara LC, Wolosker N, et al. Obesity decreases time to claudication and delays post-exercise hemodynamic recovery in elderly peripheral arterial disease patients. Gerontology. 2009;55:21-26. https://doi.org/10.1159/000155219
  10. Mannarino E, Pasqualini L, Innocente S, Scricciolo V, Rignanese A, Ciuffetti G. Physical training and antiplatelet treatment in stage II peripheral arterial occlusive disease: alone or combined? Angiology. 1991;42(7):513-521. https://doi.org/10.1177/000331979104200701
  11. Cohen EA, Creager MA, Easton JD, Hamm CW, Hankey GJ, Johnston SC, Mak KH, Mas JL, Montalescot G, Pearson TA, Steg PG, Steinhubl SR, Weber MA, Fabry-Ribaudo L, Hu T, Topol EJ, Fox KA. Patients with prior myocardial infarction, stroke, or symptomatic peri- pheral arterial disease in the CHARISMAtrial. J Am Coll Cardiol. 2007;49(19):1982-1988. https://doi.org/10.1016/j.jacc.2007.03.025
  12. Hiatt WR, Fowkes FG, Heizer G, Berger JS, Baumgartner I, Held P, Katona BG, Mahaffey KW, Norgren L, Jones WS, Blomster J, Millegard M, Reist C, Patel MR. Ticagrelor versus clopidogrel in symptomatic peripheral artery disease. N Engl J Med. 2017;376:32-40. https://doi.org/10.1056/NEJMoa1611688
  13. Whayne TF. A review of the role of anticoagulation in the treatment of peripheral arterial disease. Int J Angiol. 2012 Dec;21(4):187-194. https://doi.org/10.1055/s-0032-1330232
  14. Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: Management of asymptomatic disease and claudication. J Vasc Surg. 2015 Mar;61(3 Suppl):54S-73S. https://doi.org/10.1016/j.jvs.2014.12.007119
  15. Salhiyyah K, Forster R, Senanayake E, Abdel-Hadi M, Booth A, Michaels JA. Pentoxifylline for intermittent claudication (review). Cochrane Database Syst Rev. 2015 Sep 29;9:CD005262. https://doi.org/10.1002/14651858.CD005262.pub3
  16. Stewart AH, Lamont PM. Exercise training for claudication. Surgeon. 2007 Oct;5(5):291-299. https://doi.org/10.1016/S1479-666X(07)80028-X
  17. Creager MA, Pande RL and Hiatt WA. A randomized trial of iloprost in patients with intermittent claudication. Vascular Surgery. 2008. https://doi.org/10.1177/1358863x07084910
  18. Schellong S, Baron Von Bilderling P, Grus JD, Lawall H, Grieger F, Ney U, et al. Intravenous alprostadil treatment compared to oral pentoxifylline treatment in outpatients with intermittent claudication: results of a clinical study. Vasa Journal of Vascular Diseases. 2012;41:78. https://doi.org/10.1024/0301-1526/a000639
  19. Chacon-Quevedo A, Eguaras MG, Calleja F, Garcia MA, Roman M, Casares J, et al. Comparative evaluation of pentoxifylline, buflomedil, and nifedipine in the treatmentof intermittent claudication of the lower limbs. Angiology. 1994;45(7):647-653. https://doi.org/10.1177/000331979404500708
  20. Sallustio F, Rotondo F, Di Legge S, Stanzione P. Cilostazol in the management of atherosclerosis. Current Vascular Pharmacology. 2010;8(3):363-372. https://doi.org/10.2174/157016110791112331
  21. Chapman TM, Goa KL. Cilostazol: a review of its use in intermittent claudication. American Journal of Cardiovascular Drugs. 2003;3(2):117-138. https://doi.org/10.2165/00129784-200303020-00006
  22. Dawson DL. Comparative effects of cilostazol and other therapies for intermittent claudication. American Journal of Cardiology. 2001;87(12A):19D-27D. https://doi.org/10.1016/S0002-9149(01)01673-3
  23. Strandness DEJr, Dalman RL, Panian S, Rendell MS, Comp PC, Zhang P, et al. Effect of cilostazol in patients with intermittent claudication: a randomized, double-blind, placebo-controlled study. Vascular and Endovascular Surgery. 2002;36(2):83-91. https://doi.org/10.1177/153857440203600202
  24. Dawson DL, Cutler BS, Meissner MH, Strandness DE Jr. Cilostazol has beneficial effects in treatment of intermittent claudication: results from a multicenter, randomized, prospective, double-blind trial. Circulation. 1998;98(7):678-686. https://doi.org/10.1161/01.CIR.98.7.678
  25. Dawson DL, Cutler BS, Hiatt WR, Hobson RW. 2nd, Martin JD, Bortey EB, et al. A comparison of cilastazol and pentoxifylline for treating intermittent claudication. American Journal of Medicine. 2000;109(7):523-530. https://doi.org/10.1016/S0002-9343(00)00569-6
  26. Elam MB, Heckman J, Crouse JR, Hunninghake DB, Herd JA, Davidson M, et al. Effect of the novel antiplatelet agent cilostazol on plasma lipoproteins in patients with intermittent claudication. Arteriosclerosis, Thrombosis, and Vascular Biology. 1998;18(12):1942-1947. https://doi.org/10.1161/01.ATV.18.12.1942
  27. Money SR, Herd JA, Isaacsohn JL, Davidson M, Cutler B, Heckman J, et al. Effect of cilostazol on walking distances in patients with intermittent claudication caused by peripheralvascular disease. Journal of Vascular Surgery. 1998;27(2):267-274. https://doi.org/10.1016/j.ejvs.2009.06.002
  28. Otsuka 21-95-201. A randomised double-blind study of the safety and efficacy of two different doses of cilostazol versus placebo in patients with intermittent claudication secondary to peripheral vascular disease. Accessed May 2014. www.accessdata.fda.gov/drugsatfda˙docs/nda/99/20863.cfm
  29. Dawson DL, Cutler BS, Hiatt WR, Hobson RW. 2nd, Martin JD, Bortey EB, Forbes WP, Strandness DEJr. A comparison of cilostazol and pentoxifylline for treating intermittent claudication. Am J Med. 2000 Nov;109(7):523-530. https://doi.org/10.1016/S0002-9343(00)00569-6
  30. Lee TM, Su SF, Hwang JJ, Tseng CD, Chen MF, Lee YT, et al. Differential lipogenic effects of cilostazol and pentoxifylline in patients with intermittent claudication: potential role for interleukin-6. Atherosclerosis 2001;158(2):471-476. https://doi.org/10.1016/S0021-9150(01)00457-9
  31. Kieffer E, Bahnini A, Mouren X, Gamand S. A new study demonstrates the efficacy of naftidrofuryl in the treatment of intermittent claudication. Findings of the Naftidrofuryl. Clinical Ischemia Study (NCIS). Int Angiol. 2001;20:58-65.
  32. Adhoute G, Bacourt F, Barral M, Cardon JM, Chevalier JM, Cuny A, et al. Naftidrofuryl in chronic arterial disease. Results of a six month controlled multicenter study using Naftidrofuryl tablets 200 mg. Angiology. 1986;37:160-167. https://doi.org/10.1177/000331978603700304
  33. Stevens JW, Simpson E, Harnan S, Squires H, Meng Y, Thomas S, Michaels J and Stansby G. Systematic review of the efficacy of cilostazol, naftidrofuryl oxalate and pentoxifylline for the treatment of intermittent claudication. Br J Surg. 2012 Dec;99(12):1630-8. https://doi.org/10.1002/bjs.8895
  34. Luo T, Li J, Li L, Yang B, Liu C, Zheng Q, Jin B, Chen Z, Li K, Zhang X, Zhang J. A study on the efficacy and safety assessment of propionyl-L-carnitine tablets in treatment of intermittent claudication. Thromb Res. 2013 Oct;132(4):427-432. https://doi.org/10.1016/j.thromres.2013.08.005
  35. Shilov AM, Knyazeva LV. Pleiotropic Effects and Cardioprotective Action of Actovegin in Patients with Coronary Heart Disease. The Journal of General Medicine. 2012;4:64-73. (In Russ.) https://cyberleninka.ru/article/n/pleyotropnye-effekty-aktovegina-i-ego-kardioprotektivnoe-deystvie-u-bolnyh-s-ishemicheskoy-boleznyu-serdtsa
  36. Machicao F, Muresanu DF, Hundsberger H, et al. Pleiotropic neuroprotective and metabolic effects of Actovegin’s mode of action. J Neurol Sci. 2012 Nov 15;322(1-2):222-227. https://doi.org/10.1016/j.jns.2012.07.069
  37. Buchmayer F, Pleiner J, Elmlinger MW, et al. Actovegin: a biological drug for more than 5 decades. Pharmateka. 2012;6:20-27. (In Russ.) https://doi.org/10.1007/s10354-011-0865-y
  38. Ostroumova OD, Bobrova LS. Actovegin capabilities in increasing cognitive functions aong patients with vascular deceases of brain. Atmoshpere. Neural deseases. 2006;3:28-32. (In Russ.) https://cyberleninka.ru/article/n/vozmozhnosti-aktovegina-v-uluchshenii-kognitivnyh-funktsiy-u-patsientov-s-sosudistymi-zabolevaniyami-golovnogo-mozga
  39. Giarola P. Effects of blood extract on plasma lipids, blood coagulation, fibrinolysis, and platelet aggregation in experimental hypercholesterolemia of rabbits. Arzneim-Forsch. 1974;24:925-928.
  40. Fomin AA, Pershakov DR. Actovegin in treatment of critical limb ischemia. Khirurgiia. 2015;8:54-57. (In Russ.) https://doi.org/10.17116/hirurgia2015854-57
  41. Gaddi A, et al. Metaanalysis of some results of clinical trials on sulodexide therapy in peripheral occlusive arterial disease. The journal of international medical research. 1996;24:389-406. https://doi.org/10.1177/030006059602400501
  42. Ouma GO, Jonas RA, Usman MH, Mohler ER III. Targets and delivery methods for therapeutic angiogenesis in peripheral artery disease. Vascular Meditsine. 2012;17(3):174-192. https://doi.org/10.1177/1358863X12438270
  43. Kitsis RN, Mann DL. Apoptosis and the heart: a decade of progress. J Mol Cell Cardiol. 2005;38:1-2. https://doi.org/10.1016/j.yjmcc.2004.11.008
  44. Lederman RJ, Tenaglia AN, Anderson RD, Hermiller JB, Rocha-Singh K, Mendelsohn FO, et al. Design of the therapeutic angiogenesis with recombinant fibroblast growth factor-2 for intermittent claudication (TRAFFIC) trial. American Journal of Cardiology. 2001;88(2):192-195. https://doi.org/10.1016/S0002-9149(01)01622-8
  45. Rajagopalan S, Mohler III E, Lederman RJ, Saucedo J, Mendelsohn FO, Olin J, et al. Regional angiogenesis with vascular endothelial growth factor (VEGF) in peripheral arterial disease: design of the RAVE trial. American Heart Journal. 2003;145(6):1114-1118. https://doi.org/10.1016/S0002-8703(03)00102-9
  46. Deev R, Bozo I, Mzhavanadze N, Voronov D, Gavrilenko A, Chervyakov Y, et al. pCMV-vegf165 intramuscular gene transfer is an effective method of treatment for patients with chronic lower limb ischemia. Journal of Cardiovascular Pharmacology and Therapeutics. 2015;20(5):473-482. https://doi.org/10.1177/1074248415574336
  47. Lazarous DF, Unger EF, Epstein SE, Stine A, Arevalo JL, Chew EY, et al. Basic fibroblast growth factor in patients with intermittent claudication: results of a phase I trial. Journal of the American College of Cardiology. 2000;36(4):1239-1244. https://doi.org/10.1016/S0735-1097(00)00882-2
  48. Cooper LTJr, Hiatt WR, Creager MA, Regensteiner JG, Casscells, Isner W, et al. Proteinuria in a placebo-controlled study of basic fibroblast growth factor for intermittent claudication. Vascular Meditsine. 2001;6(4):235-239. https://doi.org/10.1177/1358836x0100600406
  49. Lederman RJ, Mendelsohn FO, Anderson RD, Saucedo JF, Tenaglia AN, Hermiller JB, et al. Therapeutic angiogenesis with recombinant fibroblast growth factor-2 for intermittent claudication (the TRAFFIC study): a randomised trial. Lancet. 2002;359(9323):2053-2058. https://doi.org/10.1016/S0140-6736(02)08937-7
  50. Kibbe MR, Hirsch AT, Mendelsohn FO, Davies MG, Pham H, Saucedo J, et al. Safety and efficacy of plasmid DNA expressing two isoforms of hepatocyte growth factor in patients with critical limb ischemia. Gene Therapy. 2016;23:306-312, 399 (corrigendum). https://doi.org/10.1038/gt.2016.9
  51. Matyas L, Schulte KL, Dormandy JA, Norgren L, Sowade O, Grotzbach G, et al. Arteriogenic gene therapy in patients with unreconstructable critical limb ischemia: a randomized, placebo-controlled clinical trial of adenovirus 5-delivered fibroblast growth factor-4. Human Gene Therapy. 2005;16(10):1202-1211. https://doi.org/10.1089/hum.2005.16.1202
  52. Muona K, Mäkinen K, Hedman M, Manninen H, Yla S. 10-year safety follow-up in patients with local VEGF gene transfer to ischemic lower limb. Herttuala Gene Therapy. 2012;19:392-395. https://doi.org/10.1038/gt.2011.109
  53. Gorenoi V, Brehm MU, Koch A, Hagen A Growth factors for angiogenesis in peripheral arterial disease (review). Cochrane Database Syst Rev. 2017 Jun 8;6:CD011741. https://doi.org/10.1002/14651858.CD011741.pub2
  54. Chervyakov YuV, Staroverov IN, Vlasenko ON, Bozo IYa, Isaev AA, Deev RV. Five-year results of treating patients with chronic lower limb ischaemia by means of gene engineering. Angiol Sosud Khir. 2016;22(4):38-43. (In Russ.)
Contact the author
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.

Email Confirmation

An email was sent to test@gmail.com with a confirmation link. Follow the link from the letter to complete the registration on the site.

Email Confirmation

Contact us
If you have any questions, complaints or suggestions, please use this feedback form.
Email
Message
The publishing house "Media Sphere" does not provide treatment services, does not give recommendations on contacting medical institutions and specific specialists, on the prescription of medicines and dietary supplements.
Submit Application

You can become an author of one of our magazines, send a request and we will consider it in during the day.

Name
Phone
E-mail
Message
Login
Registration
E-mail
Password
Forgot Password?

Log in to the site using your account in one of the services

Password recovery
E-mail
Login
Register

We use cооkies to improve the performance of the site. By staying on our site, you agree to the terms of use of cооkies. To view our Privacy and Cookie Policy, please. click here.