Nonrevascularizable buttock claudication improved with Sildenafil: A case report

Abstract

Rationale: Sildenafil, a phosphodiesterase-5-inhibitor (PDE5i), could represent a new treatment in addition to the medical treatment and advice to walk in peripheral arterial disease (PAD).

Patient concerns and diagnoses: We report a case of a 62-year-old heavy smoker man who developed a buttock claudication and a severe walking limitation following an aorto-bi-femoral bypass in 1992. Since 2003, each year, he has been referred for investigation of bilateral buttock claudication on treadmill using transcutaneous oxygen pressure (tcpO2) measurement during exercise to argue for the vascular origin of the walking impairment. He had a severe bilateral buttock ischemia and the maximum walking distance (MWD) he reached was 258 m in 2011 despite the medical optimal treatment and walking rehabilitation. Ethical approval is not necessary for this case report according to the French legislation and written consent to publication was obtained from the patient.

Interventions: Sildenafil, 100 mg/d, was introduced in February 2015 and the MWD increased to 310 m only after 2 h after the first oral intake, then to 713 m after 3 weeks, and finally to 1313 m in January 2017.

Outcomes: Recently, the patient is treated with Sildenafil 100 mg/d. He has no more pain during walking and his quality of life has improved.

Main lessons to learn: Sildenafil, a PDE5i, may represent a new therapeutic option in addition to the conventional optimal medical therapy in patients with arterial claudication. tcpO2 measurement during exercise is a promising technique for the diagnosis and monitoring of patients with PAD. A crossover, double-blind, prospective randomized monocenter study (ARTERIOFIL-NCT02832570) and a double-blind prospective randomized multicenter study (VALSTAR-NCT02930811) are ongoing to confirm our original observation.

Figures

Figure 1

Typical example of exercise-tcpO2 recording showing bilateral proximal but no distal ischemia during the walking period, before (February 2015; panel 1), after 1 month treatment (March 2015; panel 2), then after 10 months treatment (December 2015; panel 3), follow by 1 year treatment (February 2016; panel 4), and finally after 2 years treatment (January 2017; panel 4) with Sildenafil 100 mg/d. Note that from minute 15, speed and slope of the treadmill are progressively increased.

Figure 2

Evolution of the walking capacity on treadmill as maximal distance, before (blue squares) or after (orange and red squares) the introduction of Sildenafil during the follow-up period (2003–2017).