Conservative drug therapy and walking exercise in stage IIb peripheral arterial occlusion disease

In cases of peripheral arterial occlusion disease in Fontaine's stage IIb (PAOD IIb) with a walking distance of less than 200 m, the therapy that has priority, besides removing risk factors, is physical exercise. Very often it seems that concomitant rheological treatment with drugs is advisable to support the therapy and to improve compliance. The experience gained in the last 30 months in the treatment of PAOD IIb in a large angiological outpatient establishment is presented. All the patients were given thorough medical examination before the start of the therapy, and their angiological and rheological status was recorded. Depending on the results of the examinations, the patients with PAOD IIb were given one of three treatment variants: Patients with a haematocrit less than 43% and moderately altered rheology (group I; therapy: physical exercise). Patients with a haematocrit less than 43% and severely altered rheology, in particular increased erythrocyte rigidity (group II; therapy: physical exercise combined with naftidrofuryl treatment). Patients with a haematocrit of 43% or more and severely altered rheology (group III; therapy: physical exercise with haemodilution combined with naftidrofuryl treatment). Before the drug treatment was started, the possibility of surgical reconstruction of the vessels or angioplasty was discussed and the conservative therapy was undertaken only after surgery or when surgery had been rejected. Every course of treatment included reducing the risk factors as far as possible. All three conservative therapies were implemented for a period of at least 6 months. The increase in the walking distance was 157% (n = 27) after physical exercise alone, 238% (n = 27) with the naftidrofuryl combination therapy and 311% (n = 27) with the naftidrofuryl/haemodilution combination therapy.