Intermittent claudication

Intermittent claudication(Latin: claudicatio intermittens), also known as vascular

Intermittent claudication
claudication, is a symptom that describes muscle pain on mild exertion (ache,
cramp, numbness or sense of fatigue),[1] classically in the calf muscle, which occurs Specialty Cardiology, vascular
during exercise, such as walking, and is relieved by a short period of rest. It is surgery
classically associated with early-stage peripheral artery disease, and can progress to
critical limb ischemia unless treated or risk factors are modified.

Claudication derives from the Latin verbclaudicare, "to limp".

Contents
Signs
Causes
Diagnosis
Treatment
Epidemiology
See also
References
Further reading
External links

Signs
One of the hallmarks of arterial claudication is that it occurs intermittently. It disappears after a very 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
decreased pulse
redness when limb is returned to a "dependent" position (part of Buerger's test)
All the "P"s

Pallor increase
Pulses decreased
Perishing cold
Pain
Paraesthesia
Paralysis

Causes
Most commonly, intermittent (or vascular or arterial) claudication is due to peripheral arterial disease which implies significant
atherosclerotic blockages resulting in arterial insufficiency.Other uncommon causes are Trousseau disease,Beurger's disease,
(Thromboangitis obliterans) in which vasculitis occurs. Raynaud's phenomenon functional vasospasm.It is distinct from neurogenic
[2]
claudication, which is associated withlumbar spinal stenosis. It is strongly associated with smoking, hypertension, and diabetes.

Diagnosis
Intermittent claudication is a symptom and is by definition diagnosed by a patient reporting a history of leg pain with walking
relieved by rest. However, as other conditions such as sciatica can mimic intermittent claudication, testing is often performed to
confirm the diagnosis ofperipheral artery disease.

Magnetic resonance angiographyand duplex ultrasonographyappear to be slightly more cost-effective in diagnosing peripheral artery
disease among people with intermittent claudication than projectionalangiography.[3]

Treatment
Exercise can improve symptoms, as canrevascularization.[4] Both together may be better than one intervention of its own.
[4]

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 inhibitors, beta-blockers, antiplatelet agents
(aspirin and clopidogrel), naftidrofuryl, pentoxifylline, and cilostazol (selective PDE3 inhibitor) are used for the treatment of
intermittent claudication.[5] However, medications will not remove the blockages from the body. Instead, they simply improve blood
flow to the affected area.[6]

Catheter-based intervention is also an option. Atherectomy, stenting, and angioplasty to remove or push aside the arterial blockages
are the most common procedures for 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.

Epidemiology
Atherosclerosis affects up to 10% of the Western population older than 65 years and for intermittent claudication this number is
around 5%. Intermittent claudication most commonly manifests in men older than 50 years.

One in five of the middle-aged (65–75 years) population of the United Kingdom have 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 limbs
on exercise—intermittent claudication.[7]

See also
Peripheral artery disease

References
1. "intermittent claudication(https://archive.org/web/20090616022448/http://www
.mercksource.com/pp/us/cns/cns_hl_d
orlands_split.jsp?pg=/ppdocs/us/common/dorlands/dorland/nine/000953879.htm) " at Dorland's Medical Dictionary
2. Dr Hicks, Rob. "Intermittent Claudication"(http://www.bbc.co.uk/health/physical_health/conditions/intermittentclaudic
ation1.shtml). BBC Health.
3. Visser K, Kuntz KM, Donaldson MC, GazelleGS, Hunink MG (2003). "Pretreatment imaging workup for patients with
intermittent claudication: a cost-effectiveness analysis". J Vasc Interv Radiol. 14 (1): 53–62. PMID 12525586 (https://
 www.ncbi.nlm.nih.gov/pubmed/12525586).
4. Frans, FA; Bipat, S; Reekers, JA; Legemate,DA; Koelemay, MJ (January 2012). "Systematic review of exercise
training or percutaneous transluminal angioplasty for intermittent claudication".
The British journal of surgery. 99 (1):
16–28. doi:10.1002/bjs.7656 (https://doi.org/10.1002%2Fbjs.7656). PMID 21928409 (https://www.ncbi.nlm.nih.gov/p
ubmed/21928409).
5. Vascular, Team (2015-01-31). "Intermittent Claudication Treatment India" (http://www.vascularsurgerydelhi.com/inter
mittent-claudication.html). VascularSurgery.
6. National Institute for Health and Care Excellence, (Published date: 25 May 2011). " "Cilostazol, naftidrofuryl oxalate,
pentoxifylline and inositol nicotinate for the treatment of intermittent claudication in people with peripheral arterial
disease" " (https://www.nice.org.uk/guidance/ta223). Retrieved July 28, 2016.
7. "Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general
population". Int J Epidemiol. 20 (2): 384–92. Jun 1991.doi:10.1093/ije/20.2.384 (https://doi.org/10.1093%2Fije%2F2
0.2.384). PMID 1917239 (https://www.ncbi.nlm.nih.gov/pubmed/1917239).

Further reading
Burns P, Gough S, Bradbury AW (March 2003). "Management of peripheral arterial disease in primary care" . BMJ.
326 (7389): 584–8. doi:10.1136/bmj.326.7389.584. PMC 1125476 . PMID 12637405.
Shammas NW (2007)."Epidemiology, classification, and modifiablerisk factors of peripheral arterial disease". Vasc
Health Risk Manag. 3 (2): 229–34. doi:10.2147/vhrm.2007.3.2.229. PMC 1994028 . PMID 17580733.

External links
Classification ICD-10: I73.9 · D
ICD-9-CM: 440.21 ·
Cochrane Peripheral Vascular Diseases Review Group
MeSH: D007383

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