Reversal of Lower-Extremity Intermittent Claudication and Rest Pain by Hydration

  • Samuel Fernández
    Affiliations
    Trinidad Hospital, San Isidro, Buenos Aires, Argentina

    Chief of Vascular Surgery, Hospital Malvinas Argentinas, Buenos Aires, Argentina
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  • Juan Carlos Parodi
    Correspondence
    Correspondence to: Juan Carlos Parodi, MD, Don Bosco 3235, San Isidro, Pcia. De, Buenos Aires 1642, Argentina
    Affiliations
    Trinidad Hospital, San Isidro, Buenos Aires, Argentina

    Chief of Vascular Surgery, Trinidad Hospital, Buenos Aires, Argentina

    Adjunct Professor of Surgical Research, University of Michigan School of Medicine, Ann Arbor, MI

    Honorary Professor University of Buenos Aires School of Medicine, CABA, Argentina
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  • Fabián Moscovich
    Affiliations
    Trinidad Hospital, San Isidro, Buenos Aires, Argentina

    Chief of Physical Therapy, Hospital Malvinas Argentinas, Buenos Aires, Argentina
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  • Camilo Pulmari
    Affiliations
    Trinidad Hospital, San Isidro, Buenos Aires, Argentina

    Adjunct Professor of Cardiology, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
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Published:February 23, 2018DOI:https://doi.org/10.1016/j.avsg.2018.01.074

      Background

      Medical treatment of disabling intermittent claudication or critical limb-threatening ischemia causing rest pain often fails or has partial response.

      Methods

      In this pilot study, 36 patients (12 females) affected by disabling intermittent claudication or rest pain of the lower extremities were exposed to a daily 3-L water intake for up to 6 weeks. Cutaneous foot temperature, ankle/brachial index, time and distance of claudication, and pain intensity were recorded before and at the completion of the hydration period.

      Results

      Patients with a mean ± SE age of 71 ± 2 years (range, 40–86) had disabling claudication (less than 100 meters) for more than 5 months while 11% reported pain at rest. A 6-week water intake of more than 2,500 mL/24 hr was achieved in 35 of the 36 patients enrolled in the study. Increased water intake was associated with significant improvements in median ankle/brachial index (from 0.60 to 0.76; P < 0.0001) and skin temperature (first dorsal right toe, from 29.95°C to 30.0°C, P < 0.001). Time and distance to report claudication of supervised treadmill exercise improved from 1.25 to 6.25 min (P < 0.0001) and from 100 meters to 535 meters (P < 0.0001), respectively.

      Conclusions

      This study suggests that hydration attained by daily water consumption of more than 2.5 L has a robust impact on reducing the symptoms of disabling claudication and rest pain caused by peripheral vascular disease.
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      Linked Article

      • Why Did I Not Think of This? Water Therapy for PAD! (Invited Commentary)
        Annals of Vascular SurgeryVol. 49
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          Advances in the treatment of peripheral artery disease (PAD) have centered around technology to improve the outcomes of endovascular therapy.1 Despite the long-term efficacy of surgical revascularization, even for patients with critical limb ischemia, minimally invasive catheter-based interventions are gaining enthusiasm among clinicians of many specialties.2 Historically, medical therapy for PAD has been limited to anti-atherosclerosis treatment to modify the comorbidities of coronary and cerebrovascular diseases.
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