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Frequently Asked Questions

What is intermittent claudication?

Short Answer

Intermittent claudication is pain and fatigue felt in the limbs due to insufficient blood flow.

Long Answer

Intermittent claudication is an early symptom of peripheral artery disease (PAD) caused by atherosclerosis (narrowing and hardening of the arteries). It's characterized by pain, cramping, and tiredness felt in the legs during exercise although it can sometimes occur in the arms, too.

When blood flow to the legs is restricted due to PAD, there's not enough oxygen supplied to meet the increased needs of the muscles during exercise. In most cases, the pain subsides during rest which is why it's called intermittent claudication.

The diagram below shows the areas in the lower half of the body that can be affected (left) with the arteries that are usually implicated (right). In most cases, symptoms are felt in the calf.

Intermittent claudication in the legs

Symptoms

Symptoms of intermittent claudication include:

  • Pain, cramping, numbness, or fatigue in the hip, thigh, or calf during activities such as walking or climbing stairs
  • Discomfort subsides when activity is discontinued, although it may take a few minutes.
  • Sores on the feet that heal slowly or not at all
  • The skin has a pale or bluish colour.
  • Loss of hair on the legs
  • Slow growth of toenails
  • One leg or foot colder than the other
  • Erectile dysfunction in men

The table below shows the progression of intermittent claudication.

Claudication Stages (Fontaine classification)
Stage 1 No symptoms
Stage 2 Intermittent claudication
Stage 2a Pain after more than 200 meters (219 yards) of walking
Stage 2b Pain after less than 200 meters (219 yards) of walking
Stage 3 Rest pain
Stage 4 Ulceration or gangrene

Even at the early stages, it's crucial to seek medical help because the presence of intermittent claudication puts you at risk for heart attack and stroke.

Risk Factors

  • Smoking or a history of smoking (major risk factor)
  • Diabetes mellitus (major risk factor)
  • Age, especially after age 50
  • Obesity
  • Physical inactivity
  • Personal or family history of:
    • Atherosclerosis
    • High blood pressure (hypertension)
    • High blood cholesterol or triglycerides
    • Coronary heart disease
    • Stroke
  • African Americans are at a higher risk than Caucasians or Asians.

Diagnosis

Your doctor will discuss your symptoms, your medical history, and then perform a physical exam. Based on your symptoms, this may include checking for weak arterial pulses in the legs, listening for abnormal sounds in the arteries using a stethoscope, and looking for changes in skin or nail colour.

Your doctor may perform a simple test called the ankle-brachial index (ABI) which compares blood pressure readings of the ankles and arms. In a healthy person, ankle pressure is at least 90% of that in the arms. In someone with PAD, ankle pressure can be less than 50%.

Further tests may be ordered such as:

  • Blood tests to check for high blood pressure, high cholesterol levels, and kidney function
  • A Doppler ultrasound test to measure blood flow and detect blockages
  • A Pulse Volume Recording (PVR) in which blood pressure readings are taken at various points on the arms and legs
  • Computed Tomographic Angiography (CTA) to examine arteries and blood flow using x-rays
  • Magnetic Resonance Angiography (MRA) provides similar information to a CTA without the use of x-rays

Treatment

Treatment involves controlling the underlying peripheral artery disease and reducing the symptoms of intermittent claudication. Lifestyle changes such as quitting smoking, losing weight, and eating a healthy diet high in fiber and low in fats and cholesterol will help control PAD. Your doctor may also prescribe medication for high blood pressure, high cholesterol levels, and/or diabetes.

To reduce symptoms of intermittent claudication, your doctor may recommend a supervised exercise program tailored to your individual needs. Exercise has proven benefits for patients with intermittent claudication such as increasing the distance one can walk without experiencing pain, improving circulation, discouraging further buildup of cholesterol in the arteries, helping with weight loss, and it can have a positive effect on one's psychological outlook.

In addition, Cilostazol or Pentoxifylline may be prescribed. Here is a brief overview of each drug.

Cilostazol (Pletoz, Pletal)
Cilostazol works by relaxing the blood vessels to improve blood flow to the affected limbs. It helps improve walking distance, inhibits clotting, reduces triglyceride levels, and improves HDL cholesterol levels. It's not recommended for patients with certain heart conditions.
Pentoxifylline (Trental)
Pentoxifylline works by reducing the thickness or "stickiness" of the blood, allowing it flow more freely through the blood vessels to supply oxygen where it's needed. Studies on its effectiveness for treating intermittent claudication have produced mixed results. Some studies showed significant improvement on walking distances and others have shown it to be no more effective than a placebo. It may be helpful if Cilostazol is contraindicated due to a heart condition.

Additional Information

Peripheral artery disease and intermittent claudication (umm.edu)
University of Maryland Medical Center provides information on both conditions including symptoms, diagnosis, treatment, complications, and disease management.
Exercise Therapy (VascularDisease.org)
The Vascular Disease Foundation discusses exercise therapy and its benefits.
Patient information: Peripheral artery disease and claudication (Beyond the Basics) (UpToDate.com)
An in-depth look at claudication by UpToDate.
A comparison of cilostazol and pentoxifylline for treating intermittent claudication. (ncbi.nlm.nih.gov)
"CONCLUSION: Cilostazol was significantly better than pentoxifylline or placebo for increasing walking distances in patients with intermittent claudication, but was associated with a greater frequency of minor side effects. Pentoxifylline and placebo had similar effects."
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