Intermittent Claudication

Definition:
Intermittent claudication is a cramping pain felt in the calf, thigh or buttock during walking or other exercise. It is caused by lack of oxygen to the muscles because of a poor blood supply, and is relieved by rest.

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. It is commonly referred to as “intermittent” claudication because it comes and goes with exertion and rest. (In severe claudication, the pain is also felt at rest.)

Symptoms:
The term claudication comes from the Latin for ‘to limp’. The affected person doesn’t normally limp but as they walk, the pain starts to build and they limp to a standstill.

People affected describe intermittent claudication as an aching or cramping pain, accompanied by tightness or fatigue in the leg muscles or buttocks. For some, this pain arises only during strenuous activity; for others (with more severe disease of the arteries) it comes on after walking a few metres. The key factor is that the pain stops within a few minutes of resting

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
**redness when limb is returned to a “dependent” position

All the “P”s
*Increase in Pallor
*Decrease in Pulses
*Perishing cold
*Pain
*Paraesthesia
*Paralysis

Causes :
Most commonly, intermittent (or vascular or venous) claudication is due to peripheral arterial disease  (PAD), also known as peripheral vascular disease (PVD), which implies significant atherosclerotic blockages resulting in arterial insufficiency. It is distinct from neurogenic claudication, which is associated with lumbar spinal stenosis. click & see

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In people with PAD the arteries of the extremities – the feet, legs, hands and arms – become hardened or furred up (a process called arteriosclerosis) as cholesterol plaques build up on the inside of the arteries walls. This in turn obstructs blood flow.

When we walk, our muscles demand more oxygen, which is delivered through the circulation of blood. If not enough blood can get through, the muscles don’t receive enough oxygen and we experience pain.

When someone with intermittent claudication rests, the need for additional oxygen disappears and so does the pain

Intermittent claudication is much more common in men than women. It affects up to 10 per cent of people aged over 65 in developed countries. Most of those affected will also have significant disease of the coronary arteries and are at risk of heart attack and stroke.

Risk Factors:
The major risk factors for intermittent claudication include:
•Diabetes
•High cholesterol
•Smoking
•Hypertension
•Lack of physical activity
•High levels of a chemical called homocysteine
•Family history of arterial disease

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 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.

Alternative treatment:
Ginkgo biloba extract, an herbal remedy, has been used by people with intermittent claudication. The extract made from the dried leaves of the Gingko tree is thought to improve blood flow, allowing people to walk longer without pain.

However, herbal remedies are not regulated the U.S. Food and Drug Administration, and people should consult with their doctors before taking Ginkgo. Furthermore, use of this remedy could interact adversely when taken with Vitamin E and some medications.

Prognosis:
The prognosis with intermittent claudication is generally favorable because the condition often stabilizes or improves in time. Conservative treatment is advised initially.

•Walking (to gain stamina) often helps increase the distance that the patient can walk without symptoms.

•Drugs that are approved for the management of intermittent claudication include pentoxifylline (Trental) and cilostazol (Pletal).

•If medication is inadequate, correction of the narrowing in the affected artery might be suggested. Procedures used to correct the narrowing of arteries include surgery (bypass grafting) and interventional radiology (balloon angioplasty or stents).

When claudication is severe and persistent, these procedures may be required to ultimately relieve the condition and the pain. Not all persons with severe claudication can benefit from these procedures. The potential to benefit depends on the exact location and degree of artery disease and the overall health status of the patient.

Prevention:
A healthy lifestyle is the best method for preventing intermittent claudication. Cigarette smokers should quit smoking. Regular exercise and a healthy diet help reduce the risk of this condition. If necessary, people should work to lower cholesterol and blood pressure. Diabetics should strive to manage that condition, obese people should lose weight.

The methods of preventing intermittent claudication are also the means for managing the risks associated with a diagnosis of PAD.

People can learn more about peripheral vascular disease through public education programs like the free Legs for Life screenings held at sites across the nation. The program started the Society of Interventional Radiology features a free ABI testing.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:

http://www.bbc.co.uk/health/physical_health/conditions/intermittentclaudication1.shtml

http://en.wikipedia.org/wiki/Intermittent_claudication

http://www.medicinenet.com/claudication/article.htm

http://www.sscfund.org/claudication.html

http://www.downloadheart.us/what-is-intermittent-claudication.html

http://www.latrobe.edu.au/podiatry/vascular/claudication.html

http://medical-dictionary.thefreedictionary.com/intermittent+claudication

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