Intermittent claudication
Encyclopedia
Intermittent claudication (Latin: claudicatio intermittens) is a clinical diagnosis given for muscle pain (ache, cramp, numbness or sense of fatigue), 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".
The following signs are general signs of atherosclerosis of the lower extremity arteries:
All the "P"s
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.
resulting in arterial insufficiency. It is distinct from neurogenic claudication
, which is associated with lumbar spinal stenosis.
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:
- cyanosisCyanosisCyanosis is the appearance of a blue or purple coloration of the skin or mucous membranes due to the tissues near the skin surface being low on oxygen. The onset of cyanosis is 2.5 g/dL of deoxyhemoglobin. The bluish color is more readily apparent in those with high hemoglobin counts than it is...
- atrophic changes like loss of hair, shiny skin
- decreased temperatureTemperatureTemperature is a physical property of matter that quantitatively expresses the common notions of hot and cold. Objects of low temperature are cold, while various degrees of higher temperatures are referred to as warm or hot...
- decreased pulsePulseIn medicine, one's pulse represents the tactile arterial palpation of the heartbeat by trained fingertips. The pulse may be palpated in any place that allows an artery to be compressed against a bone, such as at the neck , at the wrist , behind the knee , on the inside of the elbow , and near the...
- 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
Exercise can improve symptoms; increased blood flow enhances the creation of collateral vessels to the affected muscle. However, if movement increases claudication then excessive movement is difficult if not impossible.Pharmacological options exist as well. Medicines that control lipid profile, diabetes and hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
may increase blood flow to the affected muscles and allow for increased activity levels. Angiotensin converting enzyme (ACE) inhibitors, beta-blockers, antiplatelet agents (aspirin
Aspirin
Aspirin , also known as acetylsalicylic acid , is a salicylate drug, often used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication. It was discovered by Arthur Eichengrun, a chemist with the German company Bayer...
and clopidogrel
Clopidogrel
Clopidogrel is an oral, thienopyridine class antiplatelet agent used to inhibit blood clots in coronary artery disease, peripheral vascular disease, and cerebrovascular disease. It is marketed by Bristol-Myers Squibb and Sanofi-Aventis under the trade name Plavix. The drug works by irreversibly...
), 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
Catheter
In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...
based intervention is also an option. Atherectomy
Atherectomy
Atherectomy is a minimally invasive surgical method of removing, mainly, atherosclerosis from a large blood vessel within the body. Today, it is generally used to effectively treat peripheral arterial disease of the lower extremities...
, stenting
Stent
In the technical vocabulary of medicine, a stent is an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease-induced, localized flow constriction. The term may also refer to a tube used to temporarily hold such a natural conduit open to allow...
, and angioplasty
Angioplasty
Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size...
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
Endarterectomy
Endarterectomy is a surgical procedure to remove the atheromatous plaque material, or blockage, in the lining of an artery constricted by the buildup of soft/hardening deposits. It is carried out by separating the plaque from the arterial wall....
on arterial blockages or perform an arterial bypass
Coronary artery bypass surgery
Coronary artery bypass surgery, also coronary artery bypass graft surgery, and colloquially heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease...
. However, open surgery
Invasive procedure
Invasive procedure may refer to:* "Invasive Procedures" , the fourth episode of the second season of the television series Star Trek: Deep Space Nine* Invasive Procedures , a 2007 novel by Orson Scott Card and Aaron Johnston...
poses a host of risks not present with catheter-based interventions.
Causes
Most commonly, intermittent (or vascular or venous) claudication is due to peripheral arterial disease which implies significant atherosclerotic blockagesAtherosclerosis
Atherosclerosis is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol...
resulting in arterial insufficiency. It is distinct from neurogenic claudication
Neurogenic claudication
Neurogenic claudication is a common symptom of lumbar spinal stenosis, or inflammation of the nerves emanating from the spinal cord. Neurogenic means that the problem originates with a problem at a nerve, and claudication, from the Latin for limp, because the patient feels a painful cramping or...
, which is associated with lumbar spinal stenosis.