Intermittent claudication

Intermittent claudication
Classification and external resources
ICD-10	I73.9
ICD-9	440.21
MeSH	D007383

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

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

Signs

One of the hallmarks of venous claudication is that it occurs intermittently. It disappears after a 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

All the "P's"

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

Treatment

Exercise can improve symptoms; increased blood flow enhances the creation of collateral vessels to the affected muscle. However, if movement increases claudication then excessive movement is difficult if not impossible.

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

Catheter based intervention is also an option. Atherectomy, stenting, and angioplasty to remove or push aside the arterial blockages are the most common procedures via catheter based intervention. These procedures can be performed by interventional radiologists, interventional cardiologists, vascular surgeons and thoracic surgeons, among others.

Surgery is a last option; vascular surgeons can perform either endarterectomies on arterial blockages or perform a arterial bypass. However, open surgery contains a list of risks not held by catheter based interventions.

Causes

Most commonly, intermittent (or vascular or venous) claudication is due to peripheral arterial disease which implies significant atherosclerotic blockages resulting in arterial insufficiency. It is distinct from neurogenic claudication, which is associated with spinal stenosis.

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.

Further reading

• Shammas NW (2007). "Epidemiology, classification, and modifiable risk factors of peripheral arterial disease". Vasc Health Risk Manag. 3 (2): 229–34. PMC 1994028 Freely accessible. PMID 17580733. 

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