Intermittent claudication

Intermittent claudication is one of the most insidious conditions in the body. A person diagnosed with such a disease never knows where and how his own legs will fail. A sharp pain in the hip and a feeling that no further steps are possible are the most common symptoms in those who have encountered this problem. At the same time, she is also able to suddenly let go, as well as to begin. A number of daily habits affect the development of the problem and its transformation into a chronic form. A timely decision, namely, seeking medical help, following all the recommendations and a course of therapy, will help you forget about the disease.

What is intermittent claudication?

Intermittent claudication, also known as vascular claudication, is a symptom that describes muscle pain with mild exertion (cramps, numbness, or feeling tired). The classic variant is lameness that occurs during exercise, such as walking, and resolves with a short rest period. It is associated with early stage peripheral arterial disease and may progress to critical limb ischemia unless treatment or risk factors are changed.

Intermittent claudication – painful, severe, debilitating, and sometimes burning pain in the legs that comes and goes – usually occurs when walking due to poor blood circulation in the arteries of the legs. With very advanced lameness, pain is felt even at rest. Intermittent lameness can occur in one or both legs and often progresses over time. However, some people complain only of weakness in the legs when walking and a feeling of “fatigue” in the buttocks. Impotence is a very rare complaint in men caused by lameness.

Usually the variable nature of lameness is associated with narrowing of the arteries that fill the leg with blood, limited oxygen supply to the muscles of the legs, which is felt when the oxygen demand of these muscles increases (during exercise). Intermittent claudication can be caused by short-term narrowing of an artery due to spasm, narrowing due to atherosclerosis, or arterial occlusion (closure). This condition is quite common.

Symptoms and causes of intermittent claudication

One of the hallmarks of arterial lameness is that it occurs intermittently, disappearing after a very short rest, and the patient may begin to walk again until the pain recurs. The following signs are common for atherosclerosis of the arteries of the lower extremities:

• cyanosis;
• atrophic changes such as hair loss, shiny skin;
• low temperature;
• reduced impulse;
• redness when the limb returns to the “dependent” lameness position;
• paresthesia;
• paralysis.

Causes and factors affecting intermittent claudication can include: vascular disease, smoking, hypertension, and diabetes. Most often, intermittent claudication (vascular or arterial) is due to peripheral arterial disease, which implies significant atherosclerotic blockages leading to arterial insufficiency. It is distinct from the neurogenic lameness associated with lumbar spinal stenosis. Also, the disease is directly provoked by smoking, hypertension and diabetes.

There are several other factors that cause lameness. The most important thing is the habit of smoking and irregular sports (or their complete absence). If you are a smoker, then you must make a determined effort to completely give up this negative lifestyle. Tobacco is especially harmful to those suffering from lameness, for the reason that smoking hastens the blockage of the arteries. The best way to quit is to choose a day when you are going to stop completely, instead of trying to gradually reduce the dose. If you have problems, contact your doctor, he can give advice and provide additional help. Excess weight is the main cause of vascular problems and, as a result, lameness. The more weight that the legs have to carry, the more blood the muscles themselves need. If necessary, your doctor or dietitian will create an individual diet for weight loss.

Diagnosis of intermittent claudication

Intermittent claudication is a symptom and is by definition diagnosed by a patient reporting a history of pain in the legs associated with walking. However, because other conditions (sciatica) can mimic intermittent claudication, testing is often done to confirm the diagnosis of peripheral artery disease.

Magnetic resonance angiography and duplex ultrasonography appear to be somewhat more cost-effective in diagnosing peripheral arterial disease among people with intermittent claudication than projection angiography. Exercise can improve symptoms, and revascularization also helps. Both methods together are much more effective than one intervention. Diagnostic tests include:

• measuring blood pressure to compare it in the arms and legs;
• Doppler ultrasound on the legs;
• duplex Doppler or ultrasound examination of the extremities to visualize arterial blood flow;
• ECG and arteriography (an injectable dye that can be visualized in the arteries).

The prognosis is usually favorable because the condition is able to improve over time. Doctors also recommend conservative therapy. A program of daily walking for short periods and cessation of pain or cramps often helps to increase leg function by encouraging the development of collateral circulation, that is, the growth of new small blood vessels that bypass the area of ​​obstruction in the artery.

It is necessary to quit smoking, avoid applying heat or cold on the feet, and avoid shoes that are too tight. If conservative therapy is unable to correct the situation, after diagnosis, doctors offer correction of the affected artery. This option depends on the location and degree of narrowing of the artery, as well as the patient’s underlying condition.

Testing for lameness may include:

• ultrasound is most commonly used to determine the location and degree of narrowing in blood vessels;
• the ankle index measures blood pressure compared to blood pressure in the arm (an abnormal result is a sign of peripheral artery disease);
• segmental blood pressure measures it in different parts of the leg to detect a blockage that causes a decrease in blood flow;
• computed tomography (CT) and magnetic resonance angiography (MRA) are other non-invasive tests that can help a doctor correlate blood flow in affected areas (they are considered if a doctor thinks a procedure (revascularization) to treat peripheral artery disease may be helpful) .

Pharmacological treatment options

Medications that control lipid levels, diabetes, and hypertension can increase blood flow to affected vessels and increase muscle activity. Angiotensin-converting enzyme inhibitors, beta-blockers, antiplatelet agents (aspirin and clopidogrel), naftidrofuryl, pentoxifylline, and cilostazol (a selective PDE3 inhibitor) are used to treat intermittent claudication. However, the substances will not be able to block lameness. Instead, they simply increase the level of blood flow to the affected part of the body.

A catheter-based intervention is also possible. Atherectomy, stenting, and angioplasty to remove or prevent arterial blockages are the most common interventional procedures. They can be performed by interventional radiologists, interventional cardiologists, vascular surgeons, and thoracic surgeons.

Surgery is the last resort that can be taken in the fight against this problem. Vascular surgeons perform endarterectomy for arterial blockages. However, open surgery presents a number of risks unrelated to catheter interventions.

Many are interested in the question, what could be the consequences if you do not seek medical help in time? Few patients with intermittent claudication are at risk of losing a leg due to gangrene. The task of the vascular surgeon is to prevent the result at any cost. If there is any thought that there is any risk to the limb, the specialist will always act to save the leg (if at all possible). You can minimize your risk of developing symptoms by following certain guidelines. These are the simplest measures that are the most effective. It is worth discussing the process with your doctor. The vast majority of patients do not need x-ray or surgical procedures to treat their symptoms.

Atherosclerosis affects up to 10% of the population over 65, and intermittent claudication accounts for about 5%. Periodic lameness most often occurs in men over 50 years of age. One in five of the middle-aged population (65-75 years) has evidence of peripheral arterial disease on clinical examination, although only a quarter of them have symptoms. The most common symptom is muscle pain in the lower extremities during exercise – this is intermittent lameness.