Claudication is a term which refers to pain in the legs with significant activity which is caused by atherosclerotic blockages of the arteries of the leg. Typically patients have a crampy pain in their legs after a certain amount of exercise. This pain usually goes away after a few minutes of rest.
Claudication is another condition caused by atherosclerosis, a buildup of plaque in the arteries of the body. This time, the plaque build up occurs in the arteries of the legs, or the arteries leading to the legs. In most cases, patients don't have pain without activity, but when they walk, and more blood is required to deliver oxygen to the tissues, their narrowed vessels are unable to deliver the required blood flow, and pain ensues. Therefore, when activity is stopped, blood is again delivered in adequate amounts to the tissues, and the pain goes away.
Claudication is discomfort or pain in your legs that happens when you walk and goes away when you rest. You may not always feel pain; instead you may feel a tightness, heaviness, cramping, or weakness in one or both of your legs. Claudication often occurs more quickly if you walk uphill or up a flight of stairs. Over time, you may feel claudication at shorter walking distances, as the degree of artery blockage worsens.
Claudication is a symptom of peripheral arterial disease (PAD), which is caused by atherosclerosis. Therefore, the factors which increase the risk for atherosclerosis are the same as those which increase the risk for claudication.
Risk factors for atherosclerosis include:
- High cholesterol levels in the blood
- High blood pressure
- Having a family history of heart or vascular disease
One of the most important ways that claudication is diagnosed is with a good history and physical exam. Other types of pain can mimic claudication, so it can sometimes take an experienced vascular surgeon to determine whether or not claudication is indeed present.
After your exam, if we suspect PAD and claudication, other tests may be ordered, such as:
- Ankle-brachial index (ABI), which compares the blood pressure in your arms and legs.
- Pulse volume recording, which measures the volume of blood at various points in your legs.
- Duplex ultrasound which shows blood flow in the blood vessels in the leg, and can detect the location and number of specific narrowings.
- Blood tests for cholesterol, high blood sugar or other markers for artery disease.
- Magnetic resonance angiography (MRA), which is an advanced MRI which can show the blood vessels in the legs.
- Computerized tomographic angiography (CTA), which is an advanced CT scan which can generate pictures of your blood vessels in 3D.
- Angiography, a more invasive procedure where the arteries are injected with dye and pictures are obtained.
PAD is a very serious condition because it indicates that significant atherosclerosis is present in the body. Remember, atherosclerosis is the condition that most often leads to serious and deadly conditions like heart attacks and stroke!
Therefore, we take PAD very seriously, and work with patients to strictly control their risk factors for atherosclerotic disease. We aggressively treat high blood pressure, diabetes, and high cholesterol. We help you with a real plan for regular exercise and a healthy diet, often referring you to a dietician when needed. If you are a smoker, we work with you to stop smoking at all costs. When appropriate, we test you for other conditions, such as aortic aneurysms, carotid artery disease, and heart disease, so we discover these conditions and treat them before they become dangerous. We add medications which are known to be beneficial in patients with PAD, such as aspirin and plavix in certain patients.
Exercise therapy/smoking cessation
Exercise therapy and smoking cessation are often adequate to treat claudication. Patients are instructed to exercise for 45 minutes at a time, about 5 times per week. Usually, the exercise consists of walking. Patients should walk until they experience the pain in their legs, then stop walking until the pain subsides. Once the pain goes away, they should walk again, again stopping once the pain occurs. They should continue this for 45 minutes at least five times per week. The vast majority of patients will see their pain improve over time, and may never need surgery for their atherosclerosis.
Another critical treatment for claudicating patients is smoking cessation. In addition improving general health, smoking cessation is especially effective in improving the symptoms of claudication. Often, a dramatic improvement is seen in claudicating patients when smoking is stopped.
As mentioned above, certain medications are usually started in patients with claudication. Many patients receive plavix, in order to reduce the risk of heart attacks, and most patients will receive statin therapy (like lipitor, for example) in order to lower blood cholesterol.
In a certain number of patients, therapy with medications, exercise and smoking cessation are not enough. These patients may require a procedure to fix their claudication. Endovascular surgery is a minimally invasive means of treating claudication. Vascular surgeons use angioplasty and stenting to open up the clogged blood vessels, allowing blood to flow easily in the legs. This procedure is done through a tiny puncture in the groin, using advanced x-ray techniques to deliver the balloon and stent exactly where they are needed. Ultimately, the balloon is removed, and the stent stays in place, holding the vessel open. Other techniques are also used to open up vessels, including laser, and atherectomy.
In some patients, bypass surgery is required. These patients often have long blockages in their arteries which cannot always be treated with endovascular surgery. In this case, surgeons will use either a tube of gortex (a graft), or a vein from the patient's leg (vein graft) in order to create a new route for blood to flow. Surgeons simply connect one side of the vein or graft to the artery in a location before the blockage, and the other end of the graft to the artery after the blockage. Therefore the blood has a direct route to the leg, and the delivery of blood to the leg is dramatically increased.
This procedure usually requires general anesthesia, and usually involves a few days in the hospital. Still, the results are usually dramatic, and the graft can stay open for many years. For certain patients, this is the best option to treat claudication.