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Intermittent claudication
Classification and external resources
ICD-10 I73.9
ICD-9 440.21
MeSH D007383

Intermittent claudication (Latin: claudicatio intermittens) is a clinical diagnosis given for muscle pain (ache, cramp, numbness or sense of fatigue),[1] classically calf muscle, which occurs during exercise and is relieved by a short period of rest.

Claudication derives from the Latin verb claudicare, "to limp".

In America, when intermittent claudication is discussed it is measured by the number of "city block" (e.g. 1 or 2 blocks) one can walk comfortably - the claudication distance.

Contents

Causes

Most commonly it is due to vascular intermittent claudication caused by peripheral arterial disease. Neurogenic intermittent claudication is caused by spinal canal stenosis.

It often indicates severe atherosclerosis as it is the most common cause.

Intermittent claudication in and of itself is often a symptom of severe atherosclerotic disease of the peripheral vascular system and leads to arterial insufficiency.

Presentation

One of the hallmarks of this clinical entity is that it occurs intermittently. It disappears after a brief rest and the patient can start walking again until the pain recurs.

Signs

The following signs are general signs of atherosclerosis of the lower extremity arteries:

  • cyanosis
  • atrophic changes like loss of hair, shiny skin
  • decreased temperature
  • decreased pulse
  • redness when limb is returned to a "dependent" position

All the "P's"

  • Increase in Pallor
  • Decrease in Pulses
  • Perishing cold
  • Pain
  • Paraesthesia
  • Paralysis

Treatment

Exercise can improve symptoms as do medication to control the lipid profile, diabetes and hypertension. Surgery is only indicated in severe cases with limb-threatening ischemia or lifestyle-limiting claudication. The vascular surgeon will perform an endarterectomy of leg arteries or an arterial bypass. Most patients who are very symptomatic and need revascularization are treated with angioplasty or stent placement, catheter-based minimally invasive procedures developed and usually done by interventional radiologists (see www.sirweb.org).

Angiotensin converting enzyme (ACE) inhibitors, beta-blockers, antiplatelet agents (aspirin and clopidogrel), pentoxifylline and cilostazol (selective PDE3 inhibitor) are used for the treatment of intermittent claudication. Nutritional treatments can include vitamin E and vitamin B3 supplementation.[citation needed]

The herbal medicinal product Ginkgo Biloba has also been shown to significantly improve the symptoms of intermittent claudication (superior to placebo and comparable to pentoxifylline).[citation needed]

There is a major U.S. National Institutes of Health clinical trial, through the National Heart Lung and Blood Institute, of treatments for intermittent claudication called the "CLEVER Study" (Claudication: Exercise Vs. Endoluminal Revascularization). It compares stent revascularization for blocked arteries with cilostazol medication and supervised exercise rehabiliation.

Epidemiology

Atherosclerosis affects up to 10% of the Western population older than 65 years and for intermittent claudication this number is around 5%. Intermittent claudication most commonly manifests in men older than 50 years. Moderate alcohol consumption is associated with a reduced risk of intermittent claudication.[2]

References

See also








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