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giatroi Vascular Diseases

Intermittent claudication

Please note the information provided is intended to support patients and is not a substitute for medical advice and treatment. We strongly recommend consultation with your doctor or health care professional, before using any information obtained from articles of this website.

What is intermittent claudication?

Intermittent claudication is an ache or cramp in the leg muscles (calves, thighs, buttocks, feet) that comes on when you walk and goes away when you rest. You may not feel pain but heaviness, weakness or numbness in the leg with activity. Intermittent claudication (of vascular origin) is due to reduced blood flow in the leg arteries. The blood supply to the leg is sufficient when you are resting, but not when you walk.

It often occurs more quickly if you walk faster or uphill, when the requirements of the muscles in blood and oxygen increase. Over time, you may begin to have intermittent claudication in shorter distances.

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What causes intermittent claudication?

Its most common cause is atherosclerosis. Atherosclerosis is an aging process, but occurs earlier in life in people who smoke, people with diabetes, with high blood pressure or with high cholesterol. Complicated atherosclerosis may cause narrowing (stenosis) or complete blockage (occlusion) of an artery. When this process affects the abdominal aorta, the iliac, the femoral, the popliteal or the tibial arteries, it is called peripheral occlusive arterial disease (POAD).

Occasionally, intermittent claudication may be due to a thrombosed popliteal artery aneurysm and – in general – due to occlusion of a leg artery by a clot lodged in it, but originating from a more proximal area of the arterial tree or from the heart (eg emboli sceondary to atrial fibrilation). In younger individuals, intermittent claudication may be caused by other arterial diseases, such as popliteal artery entrapment, cystic adventitial disease, Buerger’s disease (thromboangiitis obliterans) and fibromuscular dysplasia.

Some conditions, which are not vascular in origin, may cause pain in the lower limbs made worse by walking and, therefore, immitating intermittent claudication. Such conditions are:

  • Sciatica, related to spinal tube stenosis or to nerve root compression at the lumbar-sacral region of the spine (caused by disk herniation, vertebral osteophytes, spinal tumours)
  • Neurologic disorders, like diabetic polyneuropathy or other causes of neuritis
  • Musculoskeletal disorders, like osteoarthritis of hips or knees or compartment syndrome

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How can the diagnosis be made?

Initially, your physician will ask about your general health state, your symptoms and your medical history (other medical conditions and risk factors you may have). Then, he/she will examine you, especially in the abdomen and the legs (groins, behind the knees, feet) to assess the strength of your pulses in your arteries.

If your physician suspects POAD, it is possible to proceed to simple tests such as:

For more precise assessment of the extent of the disease and the severity of the blockages in your arteries – particularly if operative management is planned – the physician may organise:

  • Colour-flow duplex ultrasonography. This painless test uses ultrasounds and can show your physician how open your arteries are and how quickly blood flows through them
  • Digital subtractive angiography (DSA) of the abdominal aorta, iliac and lower limb arteries. This is an invasive test using x-rays to take pictures of the arteries by injecting contrast in them. Under local anaestesia in your groin or arm, an artery is punctured and then a catheter is advanced to the area of interest
  • Computed tomographic angiography (CTA). It uses x-rays for imaging of the blockages of the arteries
  • Magnetic resonance angiography (MRA). It uses magnetic fields and radio waves for imaging of the blockages of the arteries

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Do I need any treatment for intermittent claudication?

If your symptoms are related to atherosclerotic disease and are mild, you do not need an operation. However, because arterial disease is a warning sign for a heart attack or a stroke, you must control any risk factors like smoking, diabetes, high blood pressure, high cholesterol etc

In many patients, intermittent claudication remains stable for long periods of time or improves. If, however, it restricts your walking and this affects your lifestyle, your vascular surgeon will discuss the treatment options with you.

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What is the treatment?

After the diagnosis of the underlying condition causing intermittent claudication has been established, appropriate management may follow.

Evidently, treatment varies for each of the vascular conditions which may cause intermittent claudication, i.e. peripheral occlusive arterial disease (POAD)popliteal artery entrapment, cystic adventitial disease, Buerger’s disease (thromboangiitis obliterans) and fibromuscular dysplasia.

The vascular surgeon is the only physician qualified to offer all types of treatment for all vascular conditions which may cause intermittent claudication, and, therefore, qualified to recommend the most appropriate treatment option for the benefit of his/her patient.

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Is the treatment successful?

Conservative management with a programme of walking is very helpful and safe. Because the surgical and endovascular procedures aren’t always successful, they are usually justified only in cases of severe intermittent claudication.

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What is the risk of losing my leg?

Very few people with intermittent claudication will ever be at risk of losing a leg through gangrene, particularly if they look after themselves appropriately. The simple instructions below are very effective.

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What can I do to help myself?

You should seriously consider changes that will help avert the chances to further damage your arteries. If you don’t, you are at increased risk for a heart attack, a stroke or further problems with the circulation to your feet. These changes include:

  • Quitting smoking completely
  • Exercising aerobically, such as brisk walking, for 25 to 30 minutes daily
  • Maintaining your ideal body weight
  • Eating foods low in animal fat, cholesterol, and calories
  • Taking your medication to control blood pressure, blood cholesterol and diabetes

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Last modified 03/03/2015