Intermittent claudication

Intermittent claudication (Latin: claudicatio intermittens) is a clinical diagnosis given for muscle pain (ache, cramp, numbness or sense of fatigue),^[1] classically calf muscle, which occurs during exercise and is relieved by a short period of rest.

Claudication derives from the Latin verb claudicare, "to limp."

When intermittent claudication is discussed it is measured by the number of "blocks" (e.g. 1 or 2 blocks) one can walk comfortably - the claudication distance.

Causes

Most commonly it is due to vascular intermittent claudication caused by peripheral arterial disease. Neurogenic intermittent claudication is caused by spinal canal stenosis.

It often indicates severe atherosclerosis as it is the most common cause.

Intermittent claudication in and of itself is often a symptom of severe atherosclerotic disease of the peripheral vascular system and leads to arterial insufficiency.

Presentation

One of the hallmarks of this clinical entity is that it occurs intermittently. It disappears after a brief rest and the patient can start walking again until the pain recurs.

Signs

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

All the "P's"

• Increase in Pallor
• Decrease in Pulses
• Perishing cold
• Pain
• Paraesthesia
• Paralysis

Treatment

In patients who smoke, smoking cessation is the most effective treatment. Exercise can improve symptoms as do medication to control the lipid profile, diabetes and hypertension. Surgery is only indicated in severe cases with limb-threatening ischemia or lifestyle-limiting claudication. The vascular surgeon will perform an endarterectomy of leg arteries or an arterial bypass. Angiotensin converting enzyme (ACE) inhibitors, beta-blockers, antiplatelet agents (ASA and clopidogrel), pentoxifylline and cilostazol (selective PDE3 inhibitor) are used for the treatment of intermittent claudication.

Low molecular weight heparin (LMWH), oral anticoagulants (warfarin), or chelation therapy is not effective. According to The Natural Pharmacy 3rd Edition, which is a book published by Three Rivers Press of New York, vitamin E and vitamin B3 are some of the nutritional treatments of intermittent claudication.

The herbal medicinal product Ginkgo Biloba has also been shown to significantly improve the symptoms of intermittent claudication (superior to placebo and comparable to pentoxifylline)^{[citation needed]}.

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. Moderate alcohol consumption is associated with a reduced risk of intermittent claudication.^[2]

References

See also

• Atherosclerosis
• Peripheral artery occlusive disease
• Ankle brachial pressure index