Claudication
Claudication
refers to limping because of pain in the thigh,
calf, and/or buttocks that occurs when walking.
Claudication may be a symptom of peripheral arterial
disease (PAD). PAD is caused by a narrowing or
blockage of arteries in the legs and/or aorta
(the largest artery in the body and the primary
blood vessel leading from the heart to the body),
which may cause decreased blood flow to the muscles
of the calf, thigh, or buttocks. This decreased
blood flow may cause claudication. The pain associated
with claudication occurs with walking but disappears
at rest.
Claudication
may be a symptom of underlying systemic artery
disease and is seen more often in persons who
have blockages in other arteries, including the
heart and brain. Because claudication is associated
with an increased risk for heart attack or stroke,
its presence signals the need for assessment and
possible treatment.
About
9 million Americans, about 12 percent of the population,
experience occasional claudication. Of those who
are age 70 or more, about 20 percent are affected.
About 25 percent of people who have hardening
of the arteries (arteriosclerosis) in the legs
experience claudication.
Claudication
generally occurs when walking the same distance.
With progressive vessel disease, the initial claudication
distance (that distance at which a person first
experiences pain when walking) may decrease or
the person may no longer be able to walk.
Blockage
of an artery in the legs may cause intermittent
claudication. Atherosclerosis (a build-up of plaque,
which is a deposit of fatty substances, cholesterol,
cellular waste products, calcium, and fibrin in
the inner lining of an artery) is the most common
cause of blockage of arteries.
Blockages
in the leg are most common in the thigh and behind
the knee but may also occur at other sites in
the body including the aorta, groin, or abdomen.
A person may have more than one blockage.
As stated
above, atherosclerosis is the most common cause
of arterial blockage which can cause claudication.
Risk factors for claudication are the same as
those for atherosclerosis, and may include:
- smoking
- diabetes
- overweight or obesity
- sedentary lifestyle
- high cholesterol
- high blood pressure
- family history of atherosclerosis
or claudication
- older age (55 for men,
60 for women)
A risk
factor is anything that may increase a person's
chance of developing a disease. It may be an activity,
such as smoking, diet, family history, or many
other things. Different diseases have different
risk factors.
Although
these risk factors increase a person's risk,
they do not necessarily cause the disease. Some
people with one or more risk factors never develop
the disease, while others develop disease and
have no known risk factors. Knowing your risk
factors to any disease can help to guide you into
the appropriate actions, including changing behaviors
and being clinically monitored for the disease.
Claudication
itself is a symptom of a narrowing or blockage
of an artery. Pain, a burning feeling, or a tired
sensation in the legs and buttocks while walking
are symptoms of claudication. In some cases, the
sound of blood moving through a blockage (a whooshing
sound called a bruit), can be heard through a
stethoscope.
The
skin of the foot or leg may become shiny, hairless,
mottled (blotchy) in appearance, or may ulcerate.
The affected leg may become pale when elevated
and reddened (rubor) when lowered. Additional
symptoms that may be present in persons with claudication
include cold feet, impotence in men, and leg pain
that occurs at night when in bed. Pain that occurs
at rest may be a sign of increasing severity of
arterial disease in the leg(s).
The
symptoms related to claudication may resemble
other medical conditions or problems. Always consult
your physician for a diagnosis.
In addition
to a complete medical history and physical examination,
diagnostic procedures for claudication may include
any, or a combination, of the following:
- ankle-brachial index
(ABI) - a test in which blood pressure is taken
in the arms and in the legs. ABI is a comparison
of the blood pressure in the ankle with the
blood pressure in the arm using a regular blood
pressure cuff and a Doppler ultrasound device.
To determine the ABI, the systolic blood pressure
(the top number of the blood pressure measurement)
of the ankle is divided by the systolic blood
pressure of the arm.
- auscultation - listening
to the arteries of the legs with a stethoscope
to determine if a bruit is present.
- Doppler ultrasound
- a non-invasive test that can depict blood
flow. A Doppler probe within the ultrasound
transducer evaluates the velocity and direction
of blood flow in the vessel by bouncing high-frequency
sound waves off of red blood cells. The transducer
picks up the reflected waves and sends them
to an amplifier, which makes the ultrasonic
sound waves audible. Absence or faintness of
these sounds may indicate an obstruction to
the blood flow.
- angiogram (also called
an arteriogram) - an x-ray image of the blood
vessels that may be performed to help determine
the presence and extent of blockage. It is performed
to evaluate various vascular conditions, such
as an aneurysm (ballooning of a blood vessel),
stenosis (narrowing of a blood vessel), or blockages.
The procedure involves inserting a thin, flexible
tube into an artery in the leg and injecting
a contrast dye into the artery. The contrast
dye makes the arteries and veins visible on
the x-ray.
Specific
treatment will be determined by your physician
based on:
- your age, overall health,
and medical history
- extent of the disease
- the location of the
blockage
- your signs and symptoms
- your tolerance for
specific medications, procedures, or therapies
- expectations for the
course of the disease
- your opinion or preference
Claudication
is usually treated conservatively, with the primary
goal of treatment being modification of risk factors.
Treatment for claudication may include one or
more of the following:
- smoking cessation
- exercise, preferably
a walking program
- treatment of related
medical problems, such as high cholesterol,
high blood pressure, and/or high blood sugar
levels (glucose intolerance or type 2 diabetes).
Treatment for these problems includes diet and
exercise. In some cases, medication(s) may be
prescribed.
- prevention of blood
clots with antiplatelet medication, such as
aspirin or other medications
- medications such as
pentoxifylline or cilostazol, that may improve
walking distances in some cases
- diet low in saturated
fats
For
advanced cases in which pain is severe and/or
blood flow has been completely or almost completely
blocked, an invasive procedure such as angioplasty
(a catheter is used to create a larger opening
in the vessel to increase blood flow), stent placement
(a tiny coil is expanded inside the blocked artery
to open the blocked area and is left in place
to keep the artery open), or surgery may be needed
to open the blocked artery.
In a
small percentage of cases where all other treatments
have not been effective, amputation of the affected
limb may be necessary. Patients who smoke or who
have diabetes are at increased risk for poor outcomes
in treating claudication.
Because
many persons who have claudication also have atherosclerotic
disease such as peripheral arterial disease, coronary
artery disease, and/or blockages of the carotid
artery (carotid stenosis), aggressively modifying
risk factors for atherosclerosis can help prevent
claudication.
A prevention
plan for claudication may also be used to prevent
or lessen the progress of PAD associated with
claudication once it has been diagnosed. Consult
your physician for diagnosis and treatment.
Preventative
measures may include:
- treating high blood
pressure
- lowering low-density
lipoprotein (LDL) as directed by your physician
- lowering triglycerides
(fats in the blood)
- raising high-density
lipoproteins (HDL) as directed by your physician
- maintaining normal
weight
- increasing physical
activity, especially walking
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