title: Nonrevascularizable buttock claudication improved with Sildenafil: A case report.
abstract: BACKGROUND
  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).
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  Recently, the patient is treated with Sildenafil 100 mg/d. He has no more pain during walking and his quality of life has improved.
  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.
authors.affiliation: Vascular Investigations and Physiology Department, Angers University Hospital MitoVasc Institute, UMR CNRS 6015, INSERM U1083, Angers University, Angers, France.
authors.forename: Loukman
authors.initials: L
authors.lastname: Omarjee
authors.forename: Audrey
authors.initials: A
authors.lastname: Camarzana
authors.forename: Samir
authors.initials: S
authors.lastname: Henni
authors.forename: Pierre
authors.initials: P
authors.lastname: Abraham
mesh_terms: D002081:Buttocks / Q000098:blood supply*; D005081:Exercise Therapy; D006801:Humans; D007383:Intermittent Claudication / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010146:Pain; D058729:Peripheral Arterial Disease / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D000068677:Sildenafil Citrate / Q000627:therapeutic use*; D012907:Smoking / Q000503:physiopathology; D058017:Vascular Grafting; D016138:Walking
chemical_list: D058986:Phosphodiesterase 5 Inhibitors; D000068677:Sildenafil Citrate