Document Detail

High prevalence of proximal claudication among patients with patent aortobifemoral bypasses.
MedLine Citation:
PMID:  17264010     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Proximal (ie, buttock, hip) claudication can result from impaired perfusion in the hypogastric area after aortobifemoral bypass (ABF) despite normal femorodistal blood flow provided by the patent bypass. The proportion of patients that experience proximal claudication after ABF is unknown, and arguments for the vascular origin of symptoms specifically at the proximal level have never been reported.
METHODS: This was a prospective study set in an institutional practice of ambulatory patients referred for a systematic survey of their previous ABF bypass. Among the 131 eligible patients, 10 refused to participate and 16 were unable to walk on a treadmill. The 105 studied patients (94 men, 11 women) were a mean age of 63 +/- 10 years, and the median delay from surgery was 2 years (range, 4 months to 26 years). We used a modified version of the San Diego Claudication Questionnaire administered both at rest before the treadmill study and again after the treadmill test. Transcutaneous oxygen pressure (TcPO2) at the buttock level was used to evaluate blood flow impairment during exercise at the proximal level, with blood flow impairment defined as buttock minus chest TcPO2 decrease in excess of -15 mm Hg.
RESULTS: Thirty patients reported proximal exercise-related pain consistent with vascular criteria by history before exercise. However, 59 patients (56%) reported symptoms compatible with proximal claudication, and TcPO2 values were abnormal on one or both sides in 52. The persistence of at least one (prograde or retrograde) pathway to the hypogastric circulation, determined by review of operative details from the aortobifemoral bypass and angiography, did not significantly decrease the proportion of patients reporting proximal claudication by history (26%) or on treadmill (55%) compared with those with bilateral hypogastric occlusion (33% by history, P = .51 compared with at least one prograde hypogastric pathway and 61% based on treadmill test, P = .65 compared with at least one prograde hypogastric pathway).
CONCLUSION: The present study shows that (1) the proportion of ABF patients with a median bypass age of 2 years that report proximal claudication is high (28%), (2) this proportion is significantly higher when claudication is detected by treadmill exercise tests, (3) a vascular origin (or at least contribution) is likely 88% of the proximal symptoms observed on treadmill, (4) the presence of proximal claudication with associated abnormal TcPO(2) results increases the risk of walking impairment in affected patients, and (5) preservation of at least one internal iliac artery to allow prograde or retrograde flow to the hypogastric vascular bed does not decrease the risk of proximal claudication after ABF surgery. A vascular origin of (or at least contribution to) most of the proximal exercise-related symptoms should always be discussed in patients with patent ABF bypass.
Vincent Jaquinandi; Jean Picquet; Philippe Bouyé; Jean-Louis Saumet; Georges Leftheriotis; Pierre Abraham
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  45     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-01-31     Completed Date:  2007-03-15     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  312-8     Citation Subset:  IM    
Department of Vascular Investigations, University Hospital of Angers, Angers, France.
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MeSH Terms
Aged, 80 and over
Aorta / surgery*
Blood Gas Monitoring, Transcutaneous
Buttocks / blood supply*
Exercise Test
Femoral Artery / surgery*
Follow-Up Studies
France / epidemiology
Intermittent Claudication / epidemiology*,  etiology*
Ischemia / etiology
Middle Aged
Prospective Studies
Regional Blood Flow
Stomach / blood supply
Time Factors
Vascular Patency
Vascular Surgical Procedures / adverse effects*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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