| Intermittent claudication | |
|---|---|
| Other names | Vascular claudication, claudicatio intermittens |
| Specialty | Cardiology,vascular surgery  |
Intermittent claudication, also known asvascular claudication, is asymptom that describesmuscle pain on mild exertion (ache, cramp, numbness or sense of fatigue),[1] classically in thecalf muscle, which occurs during exercise, such as walking, and is relieved by a short period of rest. It is classically associated with early-stageperipheral artery disease, and can progress tocritical limb ischemia unless treated orrisk factors are modified and maintained.
Claudication derives from Latin claudicare 'to limp'.
One of the hallmarks of arterial claudication is that it occurs intermittently. It disappears after a very brief rest and the patient can start walking again until the pain recurs.The following signs are general signs of atherosclerosis of the lower extremity arteries:[2]
The six "P"s of ischemia[3]
Most commonly, intermittent (or vascular or arterial) claudication is due toperipheral arterial disease which implies significantatherosclerotic blockages resulting in arterial insufficiency. Other uncommon causes arecoarctation of the aorta,[4]Trousseau disease[medical citation needed] and Buerger's disease (thromboangiitis obliterans),[5] in which vasculitis occurs.
Raynaud's phenomenon functional vasospasm.[clarification needed] It is distinct fromneurogenic claudication, which is associated withlumbar spinal stenosis. It is strongly associated with smoking, hypertension, and diabetes.[6]
Intermittent claudication is a symptom and is by definition diagnosed by a patient reporting a history of leg pain with walking relieved by rest. However, as other conditions such assciatica can mimic intermittent claudication, testing is often performed to confirm the diagnosis ofperipheral artery disease.[citation needed]
Magnetic resonance angiography andduplex ultrasonography appear to be slightly more cost-effective in diagnosingperipheral artery disease among people with intermittent claudication than projectionalangiography.[7]
Exercise can improve symptoms, as canrevascularization. Both together may be better than one intervention of its own.[8]
Supervised exercise improves maximum walking distance and pain-free walking distance more than home based exercise. Although when monitoring is included in home based exercise programmes similar changes in pain-free walking distance are observed in both supervised and home based exercise.[9]
In people with stable leg pain, exercise, such asstrength training, pole-striding and upper or lower limb exercises, compared to usual care or placebo improves maximum walking time, pain-free walking distance and maximum walking distance.[10] Alternative exercise modes, such ascycling,strength training and upper-arm ergometry compared to supervised walking programmes showed no difference in maximum walking distance or pain-free walking distance for people with intermittent claudication.[11]
Pharmacological options exist, as well. Medicines that control lipid profile,diabetes, andhypertension may increase blood flow to the affected muscles and allow for increased activity levels.Angiotensin converting enzyme inhibitors,adrenergic agents such asalpha-1 blockers and beta-blockers andalpha-2 agonists, antiplatelet agents (aspirin andclopidogrel),naftidrofuryl,pentoxifylline, andcilostazol (selective PDE3 inhibitor) are used for the treatment of intermittent claudication.[12] However, medications will not remove the blockages from the body. Instead, they simply improve blood flow to the affected area.[13]
Catheter-based intervention is also an option.Atherectomy,stenting, andangioplasty to remove or push aside the arterial blockages are the most common procedures for catheter-based intervention. These procedures can be performed by interventional radiologists, interventional cardiologists, vascular surgeons, and thoracic surgeons, among others.[citation needed]
Surgery is the last resort;vascular surgeons can perform eitherendarterectomies on arterial blockages or perform anarterial bypass. However,open surgery poses a host of risks not present with catheter-based interventions.[citation needed]
Atherosclerosis affects up to 10% of the Western population older than 65 years and for intermittent claudication this number is around 5%. Intermittent claudication most commonly manifests in men older than 50 years.[citation needed]
One in five of the middle-aged (65–75 years) population of the United Kingdom have evidence of peripheral arterial disease on clinical examination, although only a quarter of them have symptoms. The most common symptom is muscle pain in the lower limbs on exercise—intermittent claudication.[14]
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