Claudication

Diagnosis

Intermittent claudication is often disregarded because many individuals assume that discomfort is a common, unpleasant aspect of getting older. Some individuals limit their physical activity to avoid pain. Despite being a symptom rather than a distinct health issue, healthcare providers will likely recommend medical tests to diagnose intermittent claudication and prevent further discomfort.

A diagnosis of claudication and peripheral artery disease is made using various methods, including a symptom review, physical examination, examination of the skin on the limbs, and blood flow tests. These tests can assist determine the source of the discomfort, rule out other conditions or problems, and guide treatment.

• Tests: Claudication may be diagnosed through the following tests:
  • Pulse measurement: in the palms, legs, or feet using a stethoscope to evaluate blood flow. The detection of weaker-than-normal or absent pulses in the legs or feet, either through touch or sound, is an alarming sign that requires attention.
  • Ankle-brachial index (ABI): Compares and evaluates the ankle and arm blood pressure. If the ankle pressure is significantly lower than the arm pressure, the patient may have claudication in one or both legs.
  • Segmental blood pressure measurement: Utilized to identify the extent and location of artery damage. A sequence of blood pressure measurements taken at several points on the arm or leg.
  • Exercise test: Establish the highest amount of exertion one can tolerate without pain or establish the farthest distance one can walk.
  • Doppler ultrasound: Show blood flow in a specific area.
  • MRI or CT angiography: Check for blood vessel constriction or determine the underlying cause of intermittent claudication.

Treatment

The treatment for claudication focuses on the management of symptoms. Since claudication increases the risk of major heart and circulatory problems, the treatment usually includes preventive measures to avoid those complications.

Intermittent claudication is rarely harmful on its own, but it might be an indication of more serious health issues. Exercise is a key component of the treatment. It alleviates pain, lengthens exercise sessions, improves vascular health in affected limbs, and aids in weight management. Long-term exercise at home is essential for continuous claudication management and and enhances overall quality of life.

To manage the pain, healthcare providers may recommend walking programs that involve walking at a pace and distance that elicits tolerable pain or claudication. Patients can take a break and rest until the pain subsides before resuming walking. The walking and resting sessions can gradually increase to 30-45 minutes, with the goal of walking at least three times per week.

• Medications: Medications are frequently used to treat intermittent claudication. These medications help improve circulation or avoid complications caused by claudication and can also minimize risk factors for heart disease. It is important to consult with a doctor before taking any medications or supplements in conjunction with the prescribed treatment to avoid any potential adverse effects or interactions. Medication may be used to treat the following conditions:
  • Pain: Cilostazol, medication that enhances blood circulation, relieve pain during workout and improves walking distances may be prescribed.
  • High cholesterol: Taking statins may increase walking distance. These drugs lower the blood cholesterol levels. Higher cholesterol levels can accelerate plaque formation in arteries. Lowering those levels helps to prevent that buildup and any associated problems, such as heart attacks.
  • Hypertension: Several drugs often relax and enlarge the blood vessels, boosting blood flow. Improving blood flow can significantly reduce or eliminate claudication-related pain. These drugs also aid in the prevention of conditions such as heart attacks and strokes.
  • Other cardiovascular risks: Prescribed medications such as aspirin and clopidogrel may be used to aid in the prevention of blood clots, lower the risk of a heart attack, stroke, or clots limiting blood flow to limbs. These drugs are collectively known as anti-platelet drugs.
• Surgical procedures: Treatment for claudication and severe peripheral artery disease may include surgery. This is often recommended if the medications fail to manage the condition. Revascularization techniques aimed at restoring blood flow can help alleviate or reduce the pain associated with intermittent claudication. Common surgical procedures include:
  • Angioplasty: This treatment increases blood flow by expanding a blocked artery. A healthcare professional guides the catheter into the blood vessels in order to deliver an inflatable balloon that stretches the artery. They can also insert a stent, which is a scaffold-like structure that keeps the artery open so blood can flow freely.
  • Vascular surgery: This surgical procedure helps blood to circulate around the restricted or obstructed artery. This technique uses a blood vessel from another part of the body to create a detour-like path for blood to go. That bypass, once in place, offers adequate blood flow to prevent intermittent claudication.