Intermittent claudication

Intermittent claudication (Latin: claudicatio intermittens) is a clinical diagnosis given for muscle pain (ache, cramp, numbness or sense of fatigue),^[1] classically in the calf muscle, which occurs during exercise, such as walking, and is relieved by a short period of rest.

Claudication derives from the Latin verb claudicare, "to limp".

Signs

One of the hallmarks of arterial claudication is that it occurs intermittently. It disappears after a 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:

• cyanosis
• atrophic changes like loss of hair, shiny skin
• decreased temperature
• decreased pulse
• redness when limb is returned to a "dependent" position

All the "P"s

• Pallor increase
• Pulses decreased
• Perishing cold
• Pain
• Paraesthesia
• Paralysis

Treatment

Exercise can improve symptoms as can angioplasty.^[2] Both together may be better than one intervention of its own.^[2]

Pharmacological options exist as well. Medicines that control lipid profile, diabetes and hypertension may increase blood flow to the affected muscles and allow for increased activity levels. Angiotensin converting enzyme (ACE) inhibitors, beta-blockers, antiplatelet agents (aspirin and clopidogrel), pentoxifylline and cilostazol (selective PDE3 inhibitor) are used for the treatment of intermittent claudication. However, medications will not remove the blockages from the body. Instead, they simply improve blood flow to the affected area.

Catheter based intervention is also an option. Atherectomy, stenting, and angioplasty to remove or push aside the arterial blockages are the most common procedures via catheter based intervention. These procedures can be performed by interventional radiologists, interventional cardiologists, vascular surgeons and thoracic surgeons, among others.

Surgery is the last resort; vascular surgeons can perform either endarterectomies on arterial blockages or perform an arterial bypass. However, open surgery poses a host of risks not present with catheter-based interventions.

Causes

Most commonly, intermittent (or vascular or arterial) claudication is due to peripheral arterial disease which implies significant atherosclerotic blockages resulting in arterial insufficiency. It is distinct from neurogenic claudication, which is associated with lumbar spinal stenosis. It is strongly associated with smoking, hypertension, and diabetes.^[3]

Epidemiology

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.

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.^[4]

References

Further reading

• Burns P, Gough S, Bradbury AW (March 2003). "Management of peripheral arterial disease in primary care". BMJ 326 (7389): 584–8. doi:10.1136/bmj.326.7389.584. PMC 1125476. PMID 12637405. 
• Shammas NW (2007). "Epidemiology, classification, and modifiable risk factors of peripheral arterial disease". Vasc Health Risk Manag 3 (2): 229–34. doi:10.2147/vhrm.2007.3.2.229. PMC 1994028. PMID 17580733.