A Simple Guide to Intermittent Claudication

A Simple Guide to Intermittent claudication
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What are Intermittent claudication?
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Intermittent claudication is a symptom of ischemic muscle pain usually in the calf muscles due to inadequate blood supply during exercise.
It is usually relieved by rest.


Who is at risk of Intermittent claudication?
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1.Age older than 65 years

2.men older than 50 years affected more than women.

3.smoking



What are the causes of Intermittent claudication?
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The causes of intermittent claudication are:

1.vascular intermittent claudication caused by peripheral arterial disease(atherosclerosis)- most common cause

2.Neurogenic intermittent claudication caused by spinal canal stenosis.



What are the symptoms of Intermittent claudication?
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The symptoms and signs are:

1.Pain in the leg especially when walking a certain distance, disappear after rest, recur again after walking

2.Paraesthesia or numbness of the leg

3.Decrease in Pulse in the leg arteries(dorsalis pedis or posterior tibial arteries)

4.Decreased in temperature due to poorer blood flow

5.Pallor of the skin of leg when leg is raised upwards to 60 degrees

6.Redness of the skin when limb is placed downwards

7.Cyanosis if blood supply to the leg is compromised

8.Atrophic changes like loss of hair

9.Bruits may be heard where the arteries are narrowed

10.Paralysis of leg if condition worsen


What are the investigations needed in assessment of Intermittent claudication?
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The type, size, location and depth of the arterial narrowing in the legs can be determined:

1.Ultrasound (non-invasive)

2.Arteriography where a dye is injected into the artery to determine the areas of narrowing.

What is the treatment for Intermittent claudication?
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In patients who smoke, smoking cessation is the most effective treatment. Exercise can improve symptoms as do Surgery is only indicated in severe cases with limb-threatening ischemia or lifestyle-limiting claudication. The vascular surgeon will perform an . Low molecular weight heparin (LMWH), oral anticoagulants (warfarin), vitamin E or chelation therapy is not effective.


A. Healthy lifestyle
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1. Stop smoking in smokers.

2. Reduce weight in the obese

3. Exercise to improve blood flow can improve symptoms

4. Foot hygiene and appropriate chiropody

B.Medical treatment:
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medication to control the

1.lipid profile - reduction of fats will reduce arteriosclerosis eg. statins

2.diabetes - reduction of blood sugar to normal reduce the risk of diabetic arteriosclerosis

3.hypertension - hypertensive drugs has been found particularly useful in the treatmeent of hypertension and intermittent claudication:

Angiotensin converting enzyme (ACE) inhibitors,'
beta-blockers,

4.blood clotting
antiplatelet agents (ASA and clopidogrel),

5.vasodilators
pentoxifylline
cilostazol ( PDE3 inhibitor)

C. Surgical treatment:
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1.endarterectomy of leg arteries

2.arterial bypass of localised areas of obstruction

3.Sympathectomy may help in some resistant cases.


What is the prognosis for Intermittent claudication?
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If treated early, prognosis is fair.

Surgical treatment is only needed if progressive gangrene develops.


How can Intermittent claudication be prevented?
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1.Stop smoking

2.Reduce weight

3.Exercise

4.Aviod prolonged walking

5.Put your feet up when sitting