Intermittent claudication

Intermittent claudication is a cramping sensation in the legs that is present during exercise or walking and occurs as a result of decreased oxygen supply. This cramping usually occurs in the calf, but may also occur in the feet. When intermittent claudication is discussed it is measured by the number of "blocks" (e.g. 1 or 2 blocks) one can walk comfortably. It often indicates severe atherosclerosis. One of the hallmarks of this clinical entity is that it occurs intermittently. It disappears after a brief rest and the patient can start walking again until the pain recurs.

Intermittent claudication in and of itself is often a symptom of severe atherosclerotic disease of the peripheral vascular system. Claudication derives from the Latin verb claudicare, "to limp."

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Signs

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"

• Increase in Pallor
• Decrease in Pulses
• Perishing cold
• Pain
• Paraesthesia
• Paralysis

Treatment

In patients who smoke, smoking cessation is the most effective treatment. Exercise can improve symptoms as do medication to control the lipid profile, diabetes and hypertension. Surgery is only indicated in severe cases with limb-threatening ischemia or lifestyle-limiting claudication. The vascular surgeon will perform an endarterectomy of leg arteries or an arterial bypass. Angiotensin converting enzyme (ACE) inhibitors, beta-blockers, antiplatelet agents (ASA and clopidogrel), pentoxifylline and cilostazol (selective PDE3 inhibitor) are used for the treatment of intermittent claudication. Low molecular weight heparin (LMWH), oral anticoagulants (warfarin), vitamin E or chelation therapy is not effective.

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.

See also

• Atherosclerosis
• Peripheral artery occlusive disease