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Nedsatt blodsirkulasjon i beina

Claudicatio intermittens, "røykeben", er smerter i beina på grunn av for dårlig blodsirkulasjon i pulsårene (arteriene).

Sener i legg og fot
Åreforkalkning, det vil si avleiring av kolesterol og fettpartikler på innsiden av blodårene, er årsaken til "røykeben"

Sist oppdatert:

11. juni 2024

Hva er claudicatio intermittens?

Claudicatio intermittens, "røykeben", er smerter i beina på grunn av for dårlig blodsirkulasjon i pulsårene (arteriene). Typisk for denne tilstanden er at du kjenner smerter og dovenhetsfølelse i leggene ved gange. Dette blir bedre ved hvile. Det kan også være smertefullt om natta, men det kan da hjelpe å sitte med beina hengende utenfor senga. Føttene er bleke og kalde, og sår på beina gror som regel langsomt.

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3 prosent av befolkningen i aldersgruppen 50-59 år har trange blodårer i bena, 5-8 prosent i aldersgruppen 60-69 år, og over 20 prosent i aldersgruppe over 80 år. Menn rammes dobbelt så hyppig som kvinner. Dersom du røyker og/eller har diabetes og/eller høyt blodtrykk, øker risikoen for trange blodårer betydelig.

Dette dokumentet er basert på det profesjonelle dokumentet Perifer arteriell sykdom . Referanselisten for dette dokumentet vises nedenfor

  1. Mazzolai L, Teixido-Tura G, Lanzi S, et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases: Developed by the task force on the management of peripheral arterial and aortic diseases of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS), the European Reference Network on Rare Multisystemic Vascular Diseases (VASCERN), and the European Society of Vascular Medicine (ESVM). Eur Heart J 2024; 45: 3538-3700. pmid:39210722 PubMed
  2. Allison MA, Ho E, Denenberg JO, et al. Ethnic-specific prevalence of peripheral arterial disease in the United States. 2007 American Journal of Preventive Medicine 2007;32:328-333
  3. Sigvant B, Wiberg-Hedman K, Bergqvist D, et al. A population-based study of peripheral arterial disease prevalence with special focus on critical limb ischemia and sex differences. J Vasc Surg. 2007;45:1185-1191 PubMed
  4. Gornik HL, Aronow HD, Goodney PP, et al. ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149: e1313-e1410. pmid:38743805 PubMed
  5. Koutakis P, Johanning JM, Haynatzki GR, et al. Abnormal joint powers before and after the onset of claudication symptoms. J Vasc Surg 2010; 52: 340-7. PubMed
  6. Joosten MM, Pai JK, Bertoia ML, et al. Associations between conventional cardiovascular risk factors and risk of peripheral artery disease in men. JAMA 2012; 308: 1660-7. Journal of the American Medical Association
  7. Thomas PE, Vedel-Krogh S, Nielsen SF, Nordestgaard BG, Kamstrup PR. Lipoprotein(a) and Risks of Peripheral Artery Disease, Abdominal Aortic Aneurysm, and Major Adverse Limb Events. J Am Coll Cardiol 2023; 82: 2265-2276. pmid:38057068 PubMed
  8. Anderson JL, Halperin JL, Albert NM, et al. Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127: 1425-43. pmid:23457117 PubMed
  9. Khan NA, Rahim SA, Anand SS, Simel DL, Panju A. Does the clinical examination predict lower extremity peripheral arterial disease?. JAMA 2006; 295: 536-46. PubMed
  10. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg 2007; 45 Suppl S:S5. PMID: 17223489 PubMed
  11. Herraiz-Adillo A, Cavero-Redondo I, Alvarez-Bueno C, et al. The accuracy of an oscillometric ankle-brachial index in the diagnosis of lower limb peripheral arterial disease: A systematic review and meta-analysis. Int J Clin Pract. 2017. PMID: 28851093 PubMed
  12. Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017; 135: 726-79. pmid:27851992 PubMed
  13. Layden J, Michaels J, Bermingham S, Higgins B. Diagnosis and management of lower limb perpheral arterial disease: summary of NICE guidance. BMJ 2012; 345: e4947. BMJ (DOI)
  14. Menke J, Larsen J. Meta-analysis: Accuracy of contrast-enhanced magnetic resonance angiography for assessing steno-. Ann Intern Med 2010; 153: 325-34. Annals of Internal Medicine
  15. Met R, Bipat S, Legemate DA, Reckers JA, Koelemay MJW. Diagnostic performance of computed tomography angiography in peripheral arterial disease. A systematic review and meta-analysis. JAMA 2009; 301: 415-24. Journal of the American Medical Association
  16. Shirasu T, Takagi H, Yasuhara J, et al. Long-term outcomes of exercise therapy versus revascularization in patients with intermittent claudication. Ann Surg 2023; 278: 172-178. PMID: 36728522 PubMed
  17. Lane R, Ellis B, Watson L, Leng GC. Exercise for intermittent claudication. Cochrane Database of Systematic Reviews 2014, Issue 7. Art. No.: CD000990. DOI: 10.1002/14651858.CD000990.pub3. DOI
  18. McDermott MM, Spring B, Tian L, et al. Effect of Low-Intensity vs High-Intensity Home-Based Walking Exercise on Walk Distance in Patients With Peripheral Artery Disease The LITE Randomized Clinical Trial. JAMA 2021; 325: 1266-76. pmid:33821898 PubMed
  19. Hageman D, Fokkenrood HJP, Gommans LNM, van den Houten MML, Teijink JAW. Supervised exercise therapy versus home‐based exercise therapy versus walking advice for intermittent claudication. Cochrane Database of Systematic Reviews 2018, Issue 4. Art. No.: CD005263. DOI: 10.1002/14651858.CD005263.pub4. DOI
  20. Mazari FA, Khan JA, Carradice D, et al. Randomized clinical trial of percutaneous transluminal angioplasty, supervised exercise and combined treatment for intermuittent claudication due to femoropopliteal arterial disease. Br J Surg 2012; 99: 39-48. PubMed
  21. Saxton JM, Zwierska I, Blagojevic M, et al. Upper- versus lower-limb aerobic exercise training on health-related quality of life in patients with symptomatic peripheral arterial disease. J Vasc Surg 2011; 53: 1265-73. PubMed
  22. Van Schaardenburgh M, Wohlwend M, Rognmo Ø, Mattsson E. Calf raise exercise increases walking performance in patients with intermittent claudication. J Vasc Surg 2017; 65: 1473-82. pmid:28285932 PubMed
  23. Stead LF, Buitrago D, Preciado N, Sanchez G, Hartmann-Boyce J, Lancaster T. Physician advice for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD000165. DOI: 10.1002/14651858.CD000165.pub4. DOI
  24. Helsedirektoratet. Nasjonal faglig retningslinje for forebygging av hjerte- og karsykdom. Helsedirektoratet. Sist faglig oppdatert: 05. mars 2018. www.helsedirektoratet.no
  25. Wong PF, Chong LY, Mikhailidis DP, Robless P, Stansby G. Antiplatelet agents for intermittent claudication. Cochrane Database of Systematic Reviews 2011, Issue 11. Art. No.: CD001272. DOI: 10.1002/14651858.CD001272.pub2. DOI
  26. Fowkes FG, Price JF, Stewart MC, et al. Aspirin for prevention of cardiovascular events in a generela population screende for a low ankle brachial index: a randomized controlled trial. JAMA 2010; 303: 841-8. Journal of the American Medical Association
  27. Paraskevas KI, Wierzbicki AS, Mikhailidis DP. Statins and noncardiac vascular disease. Curr Opin Cardiol. 2012;27(4):392–397.
  28. Bonaca MP, Nault P, Giugliano RP, et al. Low-Density lipoprotein cholesterol lowering with evolocumab and outcomes in patients with peripheral artery disease: insights from the Fourier trial (further cardiovascular outcomes research with PCSK9 inhibition in subjects with elevated risk). Circulation 2018;137:338–50. PMID: 29133605 PubMed
  29. Paravastu SCV, Mendonca DA, Da Silva A. Beta blockers for peripheral arterial disease. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD005508. DOI: 10.1002/14651858.CD005508.pub3. Accessed 11 June 2024. The Cochrane Library
  30. Eikelboom JW, Bhatt DL, Fox KAA, et al. Mortality Benefit of Rivaroxaban Plus Aspirin in Patients With Chronic Coronary or Peripheral Artery Disease. J Am Coll Cardiol. 2021 Jul 6;78(1):14-23. PMID: 34210409 PubMed
  31. Anand SS, Bosch J, Eikelboom JW, et al. Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet 2018;391:219–29. PMID: 29132880 PubMed
  32. Hess CN, Debus ES, Nehler MR, et al. Reduction in Acute Limb Ischemia With Rivaroxaban Versus Placebo in Peripheral Artery Disease After Lower Extremity Revascularization: Insights From VOYAGER PAD. Circulation 2021; 144: 1831-41. pmid:34637332 PubMed
  33. de Backer TLM, Vander Stichele R, Lehert P, Van Bortel L. Naftidrofuryl for intermittent claudication. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD001368. DOI: 10.1002/14651858.CD001368.pub4. DOI
  34. Bedenis R, Stewart M, Cleanthis M, et al. Cilostazol for intermittent claudication. Cochrane Database Syst Rev 2014; 10: CD003748. doi:10.1002/14651858.CD003748.pub4. DOI
  35. Broderick C, Forster R, Abdel-Hadi M, Salhiyyah K. Pentoxifylline for intermittent claudication. Cochrane Database of Systematic Reviews 2020, Issue 10. Art. No.: CD005262. DOI: 10.1002/14651858.CD005262.pub4. Accessed 11 June 2024. The Cochrane Library
  36. Gorenoi V, Brehm MU, Koch A, Hagen A. Growth factors for angiogenesis in peripheral arterial disease. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD011741. DOI: 10.1002/14651858.CD011741.pub2 DOI
  37. McDermott MM, Bazzano L, Peterson CA, et al. Effect of Telmisartan on Walking Performance in Patients With Lower Extremity Peripheral Artery Disease The TELEX Randomized Clinical Trial. JAMA 2022; 328: 1315-25. pmid:36194220 PubMed
  38. Cai P, Pymer S, Ibeggazene S, et al. Extracorporeal Shockwave for Intermittent Claudication and Quality of Life A Randomized Clinical Trial. JAMA Surg 2024; 159: 625-632. pmid:38598227 PubMed
  39. Fakhry F, Fokkenrood HJP, Spronk S, Teijink JAW, Rouwet EV, Hunink MGM. Endovascular revascularisation versus conservative management for intermittent claudication. Cochrane Database of Systematic Reviews 2018, Issue 3. Art. No.: CD010512. DOI: 10.1002/14651858.CD010512.pub2 DOI
  40. Antoniou GA, Georgiadis GS, Antoniou SA, Makar RR, Smout JD, Torella F. Bypass surgery for chronic lower limb ischaemia. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD002000. DOI: 10.1002/14651858.CD002000.pub3. Accessed 11 June 2024. The Cochrane Library
  41. Bradbury AW, Adam DJ, Bell J, et al. Bypass versus angioplasty in severe ischaemia if the leg (BASIL) trial: an intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy. J Vasc Surg 2010; 51: 5-17. PubMed
  42. Flørenes T, Sandbæk G, Stranden E, Jørgensen JJ. Kirurgisk behandling av aterosklerose i undersktremitetene. Tidsskr Nor Legeforen 2009; 129: 2252-5. Tidsskrift for Den norske legeforening
  43. Farber A, Menard MT, Conte MS, et al. Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia. N Engl J Med 2022. pmid:36342173 PubMed
  44. Kurth T, Rist PM, Ridker PM, et al. Association of Migraine With Aura and Other Risk Factors With Incident Cardiovascular Disease in Women. JAMA 2020; 323: 2281-9. pmid:32515815 PubMed
  45. National Institute for Health and Clinical Excellence. Lower limb peripheral arterial disease: diagnosis and management. (Clinical guideline 147) 2012
  46. Bonaca MP, Bauersachs RM, Anand SS, et al. Rivaroxaban in Peripheral Artery Disease after Revascularization. N Engl J Med. 2020. PMID: 32222135 PubMed
  47. US Preventive Services Task Force Recommendation Statement. Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment With the Ankle-Brachial Index. JAMA 2018; 320: 177-183. doi:10.1001/jama.2018.8357 DOI
  48. Robertson L, Ghouri MA, Kovacs F. Antiplatelet and anticoagulant drugs for prevention of restenosis/reocclusion following peripheral endovascular treatment. Cochrane Database Syst Rev 2012; 8: CD002071. The Cochrane Library
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