1. 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. ‘Claudication’ from the Latin word meaning ‘to limp’.
2. 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 will bring the pain on again. Blockage or narrowing in any of the arteries carrying blood to the leg can cause intermittent claudication. Trouble with the artery travelling through the thigh to supply the calf muscle is the most common cause, 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 higher up, then muscles in the thigh or the buttock may become painful. Pain often comes on more quickly when walking faster or when going up hill.
3. 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 other arteries may have started to become blocked and means that the advice below is important to try to prevent things getting worse. The arteries to the brain and to the heart muscle are the main concern.
4. Will the symptoms get better?
The symptoms of intermittent claudication are usually at their worst over the first 12 months. After this time the symptoms often stabilise. In many individuals the symptoms will improve. Improvement in symptoms is highly likely if you follow Mr Lewis’ advice about stopping smoking and doing regular walking exercise.
5. 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. Mr Lewis will discuss this with you in detail weighing up the risks and benefits of treatment.
Normally your GP will have arranged a blood test to be taken to check if you are anaemic and to check your blood sugar. You should also have a blood test to check on your blood cholesterol.
6. What treatment is there?
Give up smoking: Many people with intermittent claudication are smokers, and giving up smoking is very important. Going on smoking causes more blockages 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 small arteries in the leg to carry more blood and helps the muscles to work more efficiently. Walking two or three 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 allows. Some people find they can ‘walk through’ the pain, but it is unwise to continue if your leg becomes very painful, and especially if exercise makes you feel unwell in other ways (for example, with shortness of breath or chest pain). If you perform regular walking exercise you may see continued improvement in your walking distance with time. Other forms of exercise are good for your general health but may not improve the symptoms of intermittent claudication.
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 it difficult to lose weight: not smoking is the most important thing to do.
Antiplatelet therapy: A small dose of aspirin or clopidogrel each day helps to thin the blood, and provides some protection against blockage of arteries over the years. This medication also protects your heart.
Statins: Cholesterol is known to increase the process of ‘hardening of the arteries’. Statins are a type of medication that has been shown by research to reduce the level of cholesterol in your blood and reduce your risk of heart attacks and strokes. We recommend that all patients with symptoms of intermittent claudication are prescribed statins even if your cholesterol is “normal”
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. A medication called Cilostazol is sometimes given to patients with intermittent claudication but the benefit is controversial.
Balloon angioplasty and arterial surgery: It is sometimes possible to widen or unblock arteries using special balloons passed down the arteries under local anaesthetic (balloon angioplasty). Balloon angioplasty is usually successful at improving intermittent claudication but all operations on the arteries have possible side-effects or risks, some of these are serious. These risks are detailed in a separate information sheet. Bypass surgery in the leg is reserved for patients who have very severe symptoms.
7. What is the best treatment in your case?
Mr Lewis will discuss this with you. He will 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 x-rays after a decision that treatment by balloon angioplasty or operation might be possible. Remember, intermittent claudication may not get much worse over many years and often improves, and it seldom leads to serious trouble. If you give up smoking and keep active, no other treatment may be necessary.
If you have further questions, please do not hesitate to ask either your GP or Mr Lewis, Vascular Surgeon. Other useful sources of information regarding varicose veins and their treatment include: