- Intermittent vascular claudication usually refers to cramping pains in the legs (usually the calf muscles, but may be in the thigh muscles) caused by poor circulation of the blood in the arteries to the leg muscles during exercise.
- True claudication is relieved with rest from exercise.
- Atherosclerosis affects up to 10% of > 65 years and intermittent claudication affects >5% of >65s.
- Intermittent claudication most commonly manifests in men older than 50 years.
- Moderate alcohol consumption is associated with a reduced risk of intermittent claudication.
The following signs are general signs of atherosclerosis of the lower extremity arteries:
- atrophic changes like loss of hair, shiny skin
- redness when limb is returned to a “dependent” position – reactive hyperaemia.
All the “P’s”
- (Decreased) Pulses
- Perishing cold
p/c: affects calf, buttock, thigh, gradual onset, absent pulses, normal straight leg raise, with above ‘P’ symptoms. If spinal claudication present = cauda equina symptoms, and positive SLR.
- USS, colour duplex Doppler of main vessels.
- Ankle pressure in PVD <50mmHg, toe pressure <30mmHg.
- ABPI (ankle brachial pressure index). Normal >0.8, claudication 0.6-0.8, ischaemia <0.6.
- Intra-arterial DSA (gold standard) but invasive.
- Most commonly it is due to vascular intermittent claudication caused by peripheral arterial disease.
- Intermittent claudication in and of itself is often a symptom of severe atherosclerotic disease of the peripheral vascular system and leads to arterial insufficiency.
- Intermittent claudication is a possible symptom of anaemia.
RFs for PVD:
Smoking, DM, age, male gender, FH, hyperlipidaemia, HTN, high homocysteine (same as atherosclerosis)…
Same as angina (claudication of coronary arteries)
Hereditary? Infective? How does it spread?
Treatment and management (conservative/medical/surgical)
- Exercise can improve symptoms
- Nutritional treatments can include vitamin E and B3 supplementation.
- Medicines: ACEi, beta-blockers, antiplatelet agents (aspirin and clopidogrel), pentoxifylline and cilostazol (selective PDE3 inhibitor) are used for the treatment of intermittent claudication.
- Surgery is only indicated in severe cases with limb-threatening ischemia or lifestyle-limiting claudication.
- o Percutaneous angioplasty: increase patency of vessels (esp in aortic-iliac segment and femoral)
- o Vessel reconstruction (=neovascularisation) using long saphenous vein
- o Sympathectomy: to increase blood flow to skin and reduce pain. Inject phenol under skin with LA.
- o Amputation.
The prognosis for patients with peripheral vascular disease due to atherosclerosis is poor Patients with intermittent claudication due to atherosclerosis tend to die from cardiovascular disease (e.g. heart attack), because the same disease that affects the legs is often present in the arteries of the heart.