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Arteriosclerosis

Low Level Laser Therapy in the Treatment of Arteriosclerosis of the Lower Limbs

Attia M.A., EI-Kashef H. Laser center, Alhikmah Hospital, EI-Mansoura, Egypt Physics Department, Faculty of Science, Tanta Egypt

Abstract
Twenty patients with arteriosclerosis in the lower limbs were treated by low level laser therapy with lumbar paravertebral application a 20mW continuous wave He-Ne laser(632nm> and simultaneously a 250mW continuous diode laser (830 nm> was applied transcutaneously to the lumbar region by the scanner for 30 minutes 6 days per week for 2 months. The mean value of percentage of success was 87.2%. The results of the study indicate that low level laser therapy can influence beneficially arteriosclerosis in the lower limbs which is generally difficult to treat.

Introduction
Arteriosclerosis is a chronic obliterative disease affecting the lower portion of the aorta, its main branches and the arteries supplying the extremities. The condition occurs predominantly in patients between the ages of 45 and 70 years. It is present much more frequently in males than in females. It may be caused by an error in the metabolism of lipids (Oliver, 1955). Buck (1959) believed that the abnormal vascularization of the arterial wall has also been proposed as a significant factor in the development of the disease. Also, the Question of heredity as a factor in the pathogenesis of the disease must be raised (McKusick, 1958). The patient complains of pain in the extremities typical of intermittent calculation and difficulty in walking, finally rest pain is experienced particularly at night, characterized by a sensation of coldness or burning, hyperesthesia and tingling (Abramson, 1974). The purpose of the study was to evaluate the efficacy of low power laser in the treatment of arteriosclerosis. Materials and methods Twenty patients with arteriosclerosis of the lower limbs from the out-patient clinic of the General medicine Department of both Tanta University Hospital and Alhikmah Hospital, Mansoura were included in the study. The male to female ratio was 4:1. The ages ranged from 45 to 69 years. The duration of symptoms ranged from one to 8 months (table 1). The patients were experiencing pain in both calf muscles after walking distances (claudication distance) ranging from 200 to 500 meters. Three patients experienced rest pain at night. Clinical examinations revealed palpable walls of superficial arteries, particularly the dorsalis pedis. In the study, the claudication distance was determined for every patient in meters prior to treatment. Control normal individuals within the patients' age group walked an average of 1500 meters without experiencing calf pain.

Results
Pain was relieved in 16 patients who received 3 to 7 courses of treatment. Eight patients were able to walk 1500 meters without experiencing any pain in the calf muscles, hence their rate of success was 100%. The remaining patients showed improvement from 73% to 95 (table 2). Three patients discontinued treatment for reasons not related to the treatment. One patient, age 69, with 4 months duration and claudication distance of 240 meters showed no improvement after receiving 7 courses of treatment. The mean rate of success was 87.2%.

Discussion
It was not easy to discuss the treatment of arteriosclerosis and only in the last 20 years have advancements been made. Although physical therapy is only part of the total management of arteriosclerosis of the lower limbs, it could play an important role in the management. No references were found in literature concentrating the use of low level laser therapy in the management of arteriosclerosis. This work has shown that low level laser therapy is capable of increasing the circulation in muscles and, with prolonged treatment, a considerable significant improvement in circulation can be achieved in cases of arteriosclerosis. Low level laser therapy not only influences the superficial circulation but also deep circulation. The mechanism of this action is probably due to the sympathetic effect, but it could also be used on the action of normal skin excitation. It can be assumed that apart from the increase in the pain threshold (Nikolova, 1968) and muscular excitation threshold, there is also an increase in the threshold for sympathicus stimulation (Pabst, 1960). By this paravertebral application, we must concede more importance to the sympathicus action, than to the direct action on the vasometer assumed by some authors (Monode, 1951; Zinn, 1956). The results obtained in the treatment of arteriosclerosis by means of low level laser therapy are certainly based on a number of different effects. First, there is sympathetic action. Also, the analgesic action of this type of current deserves special attention, since it is the cause of the subjective improvement which frequently precedes the objective improvement in cases of sever arteriosclerosis when pain is felt while resting. Also, rest pain did not mean the presence of irreversible pathologic change as the three patients with rest pain showed a good degree of improvement. The patient who showed no improvement after 7 courses of treatment may have an irreversible pathologic change and, this age of 69 years may have also contributed to the failure of treatment.

Conclusion
Low level laser therapy may be considered in the treatment of peripheral arteriosclerosis.

Table 1 - Clinical data and claudication distance

No
age
sex
Duration of  pain in months
Claudication distance  in meters
1.
45
Male 
7
250
2.
50 
Male 
6
300
3.
49 
Male 
4
Rest pain
4.
55
Female 
3
360
5.
54 
Male 
4
380
6.
60
Male 
6
200
7.
58
Male 
8
320
8.
69
Male 
4
240
9.
63
Male 
3
Rest pain
10.
60
Male 
4
350
11.
62
Male 
3
380
12.
59
Male 
4
400
13.
58
Female 
5
450
14.
56
Female 
6
500
15.
60
Male 
7
300
16.
55
Male 
2
250
17.
54
Male 
1
Rest pain
18.
60
Female 
3
350
19.
64
Male 
2
300
20.
58
Male 
5
260

Table 2 - Claudication distance in metres before treatment and the distance walked without experiencing pain after treatement.

No
Distance before treatment 
Distance after treatment 
Improvement
1.
250
1300
84%
2.
300
1450
85.8%
3.
Rest pain
1100
73.3%
4.
360
1500
100%
5.
380
1500
100%
6.
200
Discontinued 
-
7.
320
1350
87.2%
8.
240
No improvement
0%
9.
Rest pain
1200
80%
10.
350
Discontinued 
-
11.
380
1500
100%
12.
400
1500
100%
13.
450
1500
100%
14.
500
1500
100%
15.
300
1500
100%
16.
250
1350
88%
17.
Rest pain
1250
83.3%
18.
350
1500
100%
19.
300
1400
91.6%
20.
260
Discontinued 
-
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