Claudication
This is very different from the pain caused by vein problems. Claudication is often initially experienced while exercising, but as the condition worsens, you can feel the pain when you’re doing any kind of physical activity. Claudication is often a symptom of peripheral artery disease, a circulation problem caused by narrowing or blockage of the arteries.
Who is at Risk?
People over the age of 70 (or those over the age of 50 who smoke or have diabetes) are most at risk. Other risk factors are high cholesterol, high blood pressure, hx of coronary disease or other peripheral artery disease.
Symptoms of Claudication
● Cramping or pain in the muscles during activity. The discomfort is completely relieved by rest. The discomfort is predictable based on the amount of the activity you participate in. Most patients describe leg cramps after a certain length of time or certain distance of walking. Although patients with claudication can also have other medical conditions, the blockage of arteries does not cause swelling, back pain or heaviness in the legs.
Tests and Treatments
Common non-invasive tests to diagnose claudication include checking the strength of a patient’s pulses. The Ankle-Brachial Index test compares the blood pressure in your ankles to the blood pressure in your arms. The ankle pressure and arm pressure should be very close to the same. Duplex ultrasound may be used to check the rate of blood flow. To see if blood vessels are damaged, magnetic resonance imaging (MRI) or Computed Tomography (CT) angiography is often used.
Dye based catheterization using angiography is still the gold standard. This is an invasive test which provides valuable information about the arteries so that a decision can be made regarding the treatment of patients with claudication. Some patients will be found to have no artery blockages even though their symptoms are thought to be claudication. In some cases, the angiogram will reveal unexpected abnormalities such as aneurysms, blood clots, cysts or abnormal muscle which are squeezing the arteries from the outside (entrapment syndrome)
Treatments options are numerous. For smokers the first step is to quit smoking. Otherwise, an exercise program is often prescribed. This appears to have the best result when done under supervision. Certain medications are available such as Pletal. Additionally, medications which alter a patient’s cholesterol, such as a statin, are being investigated to help with claudication. These studies are still underway. Most experts agree that claudication does not increase the risk of amputation. However, now that there are many different intervention available. Most commonly, a physician will attempt to open a blocked artery with endovascular techniques. This involves a variety of catheter based options such as atherectomy, balloon angioplasty, stenting and laser treatment. These endovascular procedures are all catheter based and are usually successful. Unfortunately, the sx often recur after several months. The option at that point is another endovascular procedure, or to proceed with open surgical techniques. A full discussion of the variety of surgical options is beyond the scope of this brief outline. Open surgical techniques are widely regarded as having a higher risk than endovascular techniques, but they are generally accepted as a valuable alternative for circumstances in which endovascular technique has either failed or was not possible.
