INTERMITTENT CLAUDICATION A Patient Information Sheet
The information provided in this patient information sheet is not a substitute for specialist medical advice or treatment. Christchurch Vascular Group recommends consultation with your family doctor or vascular specialist. What is intermittent claudication?
Intermittent claudication is pain in the leg brought on by walking, and is caused by poor blood flow to the muscles. It is "intermittent" because it only comes on with walking or running, and it goes away after a short rest: and "claudication" from the Latin word meaning "to limp". What causes intermittent claudication?
Narrowing or blockage of arteries to the leg is caused by atherosclerosis ("hardening of the arteries"). It means that the extra blood needed during exercise cannot reach the muscles. When muscles get short of blood they start to "seize up", with feelings of cramp, tightness, or pain. After a short rest the muscles recover, but more walking wil bring the pain on again. Blockage or narrowing in any of the arteries carrying blood to the leg can cause intermittent claudication. Trouble with arteries in the thigh is commonest, but large arteries above the level of the groin, or small arteries down in the calf can also be affected. Pain is most often felt in the calf muscles, but if larger arteries are blocked, then muscles in the thigh or the buttock may become painful. Pain often comes on more quickly when walking faster or when going up hil . There are other causes of pain in the leg on walking, and specialist examination is often needed to find out whether narrowed arteries real y are the cause. Is intermittent claudication dangerous?
No: it is a nuisance but not a danger. Most people with intermittent claudication never develop serious problems with their leg. But it is a warning sign that arteries have started to become blocked and means that the advice below is important to try to prevent things getting worse. What tests are needed?
You will have had an examination of your arteries to show whether or not they are causing your symptoms. Further tests on the arteries, such as scans or x-rays, are only necessary if special treatment is planned. We wil discuss this with you. Normally a blood test is taken to check if you are anaemic and check your blood sugar. You should be advised to have a blood test to check on your blood cholesterol. Often, your own doctor wil have done these tests for you. What treatment is there? Giving up smoking Many people with intermittent claudication are smokers, and giving up smoking is very important. Going on smoking causes more blocks and narrowings to form (both in arteries to the legs and other arteries - for example in the heart and brain increasing the risk of heart attacks and strokes). Finally, smoking makes any intervention to clear out or bypass arteries more likely to fail. Exercise Taking exercise by regular walking is the best treatment for most patients with intermittent claudication and will help symptoms to improve. Walking distance can improve a lot because exercise encourages smal arteries in the leg to carry more blood and helps the muscles to work more efficiently. Walking 3 times a week for an hour is recommended. You can stop and rest as often as you need to during these exercise sessions. You will do no harm by trying to walk as far as your comfort al ows. Some people find they can "walk through"
the pain, but it is unwise to continue if your leg becomes very painful, and especial y if exercise makes you feel unwel in other ways (for example, with shortness of breath or chest pain). You wil get further if you walk slowly, and if you stop for rests before the pain gets too bad. Diet If you are overweight, then it is helpful to lose weight by going on a diet and taking as much exercise as you are able. People who have just given up smoking often find this difficult: not smoking is the most important thing to do. Aspirin A small dose of aspirin each day helps to thin the blood, and provides some protection against blockage of important arteries over the years. This low dose of aspirin also protects your heart. If you cannot take aspirin the vascular specialist or your GP wil discuss if there is an alternative. Other medicines It is important to take any medicines you have been prescribed for diabetes, heart trouble, high blood pressure, cholesterol and other conditions which affect the circulation. Balloon angioplasty and arterial surgery It is sometimes possible to widen or unblock arteries using special bal oons passed down the arteries under local anaesthetic (bal oon angioplasty). Balloon angioplasty is usually successful in improving intermittent claudication but all operations on the arteries have possible side effects and there is a smal risk of losing the leg. Walking exercise carries none of these risks and usual y has as good an outcome as bal oon angioplasty. Bypass surgery is reserved for patients who have very severe symptoms. What is the best treatment in your case?
We will discuss this with you. We wil ask for your own opinion on how badly intermittent claudication affects your life, and what you would like done, considering all the pros and cons of treatment. We would only request scans or xrays after a decision that treatment by bal oon angioplasty or operation might be possible. If in doubt about whether to get scans or x-rays, it is often wise to wait to see if your symptoms improve, and to give you time to consider al the possibilities. Remember, intermittent claudication may not get much worse over many years and can improve, and it seldom leads to serious trouble. If you give up smoking and keep active, no other treatment may ever by necessary.
Analgesics Fact Sheet Group 1: Traditional pain medications (called analgesics) These can be tried for usual acute pain or nociceptive pain, inflammatory pain and some of these might help neuropathic pain. Paracetamol Paracetamol is available from pharmacies as tablets, liquid mixtures, or suppositories. Often paracetamol is the sole chemical, but it is also used in o Paracetamol