This condition is one of the manifestations of peripheral arterial disease. Claudication comes from the Latin for "limp". It is the most important symptom of arterial disease in extremity. It develops whenever blood flow to an exercising muscle is unable to meet the requirements of increased metabolic activity.
What are the main features of intermittent claudication?
There are 3 main features. First the pain is always experienced in a functional muscle group, such as the calf, the thigh or the buttock. Secondly it is precipitated by a consistent amount of exercise. Patients will say things like "I can walk a block and then the pain starts". The third hallmark is that the pain stops promptly when the exercising stops.
Who typically develops intermittent claudication?
Typically it is more often a man, than a woman, the patients are usually smokers and may have a history of diabetes and usually have high blood pressure. It is estimated that 4.5 million people have this condition.
What is the patient history for this condition?
Typically 60-70% will have a persistence of the symptoms, 20-25% will get worse, prompting medical attention, and 10% will require some type of surgical intervention. Surgical intervention may mean a by-pass procedure or even amputation. The rate for amputation is 1-2% a year. In addition peripheral arterial disease is often a marker of a systemic problem. Patients may also have a stroke or heart attack.
What are the risk factors?
There may be a genetic factor. Cigarette smoking is a huge risk factor, as is elevated cholesterol, diabetes and high blood pressure.
What is the usual treatment?
Education is aimed at changing habits and lifestyle choices that encourage poor circulation to the legs. This education includes smoking cessation, weight loss, treatment for elevated cholesterol, and treatment for elevated blood pressure.
Exercise is encouraged because studies have shown that continuing and increasing exercise along with smoking cessation will improve the condition.
Trental was the first drug to be used for this condition. There is also a new drug for this condition, which is showing much success in treatment. This new drug is PLETAL. This drug works by dilating the blood vessels, which increase blood flow and it, inhibits the stickiness of platelets, which cause blood to clot. Studies found there was a 40% improvement for patients taking this drug.
- Surgical Intervention
When all else fails surgery becomes the last resort. Bypass surgery can open up constricted blood vessels. Amputation is done if there is tissue death due to lack of circulation.
What are the barriers to treatment? The biggest barrier is the attitude that pain in the legs is just a normal part of aging and that a lack of communication between seniors and their doctors. Seniors are often reluctant to discuss pain when walking because they have been conditioned to think this is just a normal part of aging. The medical community had actually propagated this. This has changed and we realize it is a disease, and is treatable.