Intermittent claudication is one of the most insidious states of the body. A person diagnosed with such a disease never knows where and how his own legs will fail. A sharp pain in the thigh and a feeling that further steps are impossible are the most common symptoms of those who have encountered this problem. At the same time, it can also unexpectedly release, as well as start. A number of daily habits affect the development of the problem and its transformation into a chronic form. A timely decision, namely, seeking medical help, fulfilling all the recommendations and the course of therapy, will help to forget about the ailment.
What is intermittent claudication?
Intermittent claudication, also known as vascular lameness, is a symptom that describes muscle pain with slight exertion (cramps, numbness, or a feeling of fatigue). The classic option is lameness, which occurs during exercise, such as walking, and passes from a short rest period. This is associated with an early stage of peripheral arterial disease and can progress to critical limb ischemia, unless treatment or risk factors are changed.
Intermittent claudication - painful, severe, exhausting, and sometimes burning pain in the legs, which comes and goes - this usually happens when walking due to poor blood circulation in the arteries of the legs. With a very lamentable lameness, the pain is felt and at rest. Periodic lameness can occur on one or both legs and often worsens over time. However, some people only complain of weakness in the legs when walking and a feeling of "tiredness" in the buttocks. Impotence is a very rare complaint in men caused by lameness.
Usually, the variable nature of lameness is associated with narrowing of the arteries that fill the leg with blood, limited oxygen supply to the leg muscles, which is felt when the oxygen demand of these muscles increases (during exercise). Periodic lameness can be caused by short-term narrowing of the artery due to spasm, narrowing due to atherosclerosis or its occlusion (closure). This condition is quite common.
Symptoms and causes of intermittent claudication
One of the hallmarks of arterial lameness is that it occurs intermittently: it disappears after a very short rest, and the patient can begin to walk again until the pain repeats. The following symptoms are common for lower limb arteriosclerosis:
- atrophic changes, such as hair loss, shiny skin;
- low temperature;
- reduced impulse;
- redness when the limb returns to the “dependent” position of lameness;
The causes and factors affecting intermittent claudication can be: arterial disease, smoking, hypertension and diabetes. Most often, intermittent claudication (vascular or arterial) is caused by a peripheral arterial disease, which means significant atherosclerotic blockages leading to arterial insufficiency. It differs from neurogenic lameness associated with lumbar spinal stenosis. Also, the disease is directly provoked by smoking, hypertension and diabetes.
There are several other factors that cause lameness. The most important thing is the habit of smoking and not regular exercise (or lack thereof). If you are a smoker, you must make a determined effort to completely abandon this negative lifestyle. Tobacco is especially harmful to people with limping for two reasons: smoking speeds up the blockage of the arteries, which is the cause of the problem, cigarette smoke prevents the development of collateral vessels that enter the bloodstream due to blockade. The best way to refuse is to choose the day when you are going to stop completely, instead of trying to gradually reduce the dose. If you have problems, contact your doctor, he can give advice and provide additional help. Excess weight is the main cause of problems with blood vessels and, as a result, limping. The more weight the legs have to carry, the more blood the muscles themselves need. If necessary, your doctor or nutritionist will create an individualized diet for weight loss.
Diagnosis of intermittent claudication
Intermittent claudication is a symptom and, by definition, is diagnosed by a patient reporting a history of leg pain associated with walking. However, since other conditions (sciatica) can mimic intermittent claudication, testing is often done to confirm the diagnosis of peripheral artery disease.
Magnetic resonance angiography and duplex ultrasonography appear to be somewhat more cost-effective in diagnosing peripheral artery disease in people with intermittent claudication than projection angiography. Exercise can improve symptoms, and revascularization also helps. Both methods together are much more effective than one intervention. Diagnostic tests include:
- measuring blood pressure to compare it in the arms and legs;
- Doppler ultrasound on the legs;
- duplex Doppler or ultrasound examination of the limbs to visualize arterial blood flow;
- ECG and arteriography (injectable dye that can be visualized in the arteries).
The prognosis is usually favorable, because the condition is able to improve with time. Doctors also recommend conservative therapy. The daily walking program for short periods and the cessation of pain or cramps often helps to improve the functioning of the legs, encouraging the development of collateral circulation, that is, the growth of new small blood vessels that bypass the area of obstruction in the artery.
It is necessary to stop smoking, to avoid the use of heat or cold on the legs, as well as too tight shoes. If conservative therapy is not able to correct the situation, after diagnosis, doctors suggest correction of the affected artery. This option depends on the location and severity of the narrowing in the artery and on the patient’s underlying condition. The doctor will also take a case history and the diagnosis will be based on the patient's symptoms.
Lameness testing may include:
- ultrasound is most often used to determine the location and severity of constriction in the blood vessels;
- the ankle index measures blood pressure compared to blood pressure in the hand (an abnormal result is a sign of peripheral artery disease);
- segmented blood pressure measures it in different parts of the leg to detect a blockage that causes a decrease in blood flow;
- computed tomography (CT) and magnetic resonance angiography (MRA) are other non-invasive tests that can help the doctor compare blood flow in the affected areas (they are considered if the doctor believes that a procedure (revascularization) for the treatment of peripheral artery disease can be useful) .
Pharmacological treatment options
Medications that control lipid profile, diabetes, and hypertension can increase blood flow to affected muscles and activity level. Angiotensin-converting enzyme inhibitors, beta-blockers, antiplatelet agents (aspirin and clopidogrel), naphthidrofuryl, pentoxifylline and Cilostazol (a selective PDE3 inhibitor) are used to treat intermittent claudication. However, substances will not be able to block lameness. Instead, they simply increase the level of blood flow to the affected part of the body.
A catheter-based intervention is also possible. Arectectomy, stenting, and angioplasty to remove or prevent arterial blockage are the most common interventions. They can be performed by interventional radiologists, interventional cardiologists, vascular surgeons, and thoracic surgeons.
Surgery is the last resort that can be taken to combat this problem. Vascular surgeons perform endarterectomy for arterial blockages. However, open surgery presents a range of risks not related to catheter interventions.
Many are interested in the question, what could be the consequences if you do not seek medical help on time? Few patients with intermittent claudication are at risk of losing leg due to gangrene. The task of the vascular surgeon is to prevent the result at any cost. If there is a thought that there is any risk to the limb, the specialist will always act to save the leg (if at all possible). You can minimize the risk of developing symptoms by following certain guidelines. These are the simplest measures that are most effective. It is worth discussing the process with your doctor. The vast majority of patients do not need X-ray or surgical procedures to treat their symptoms.
Atherosclerosis affects up to 10% of the population over 65, and intermittent claudication is about 5%. Periodic lameness is most often manifested in men older than 50 years. Every fifth of the middle-aged population (65-75 years) has signs of peripheral arterial disease during clinical examination, although only a quarter of them have symptoms. The most common symptom is muscle pain in the lower extremities during exercise - this is intermittent claudication.