ABC of Vascular Disease
1. What is intermittent claudication?
Intermittent claudication (IC) is pain in the muscles of the leg which only
comes on with exercise and which is relieved by resting.
2. What causes intermittent claudication?
When you exercise the muscles of the leg they need more blood to work
properly. This blood flows in the arteries from heart to the muscles in
the leg. If these arteries are narrow or even blocked not enough blood
reaches the muscles and the muscles "complain" by producing pain (see haemodynamics)
3. What causes the arteries to become narrowed?
Arteries tend to "furr up" as you get older and the rate at which they
do so is different for each person (see atherogenesis). Smoking increases the rate at which
arteries become narrowed and once the narrowing is established the artery cannot
easily be opened up again. If artery is more than 3/4 narrowed it is
unable to carry the normal amount of blood and it is only then that you start to
notice symptoms. All the arteries in the body are affected to a greater or
lesser degree but arterial disease in the arteries to the vital organs such as
the heart itself, the brain, and the kidneys is obviously more serious.
4. What happens if the artery blocks completely?
It depends on where the artery is and how many other arteries it is connected
to. In some cases the artery my block completely and other arteries can
take over the work of supplying blood (collateral arteries). In other
cases when the artery blocks no blood can get through and the part of the body
supplied by that artery is starved of blood and the cells die: a process called
infarction. This is what happens in a heart attack when the muscle of the
heart (myocardium) loses its blood supply and dies giving a myocardial
infarction (MI). The leg has a good set of collateral arteries and can
usually tolerate a blockage in one of the main arteries. More than one
blockage is more serious and may result in infarction of the leg and infection
5. What do I do if I think I have intermittent claudication?
The first thing to do is to see your GP and discuss your symptoms. If your
GP agrees it is worth seeing a specialist and having measurements of the blood
pressure in your legs done to confirm the diagnosis.
6. How can intermittent claudication be treated?
In many cases the problem is self-limiting because the collateral arteries
slowly increase in size over several months and allow more blood to reach the
muscles. However, intermittent claudication is a warning sign that
the arteries are being damaged. There are a number of other common factors
which aggravate arterial disease and these should be looked for and treated if
|High blood pressure|
|High blood fat (cholesterol)|
Provided that you don't have chest pain or severe shortness of breath on
exercise (both signs of heart disease) then regular daily exercise is
recommended for people with claudication because
|It improves the development of collateral arteries|
|It helps with reducing weight (especially if you've had to stop smoking)|
|It improves cardiac fitness|
Aspirin tablets, when taken at lower than the normal dose will reduce the
stickiness of the blood and, although they do not have any effect on
claudication, they do reduce the risk of the arterial disease from getting worse
and causing future complications.
7. What if these first line measures do not work?
Most people find a significant improvement but if the problem persists or
worsens then it may be necessary to consider more radical treatment. For
this your GP will need to refer you to a vascular surgeon. Before the
surgeon can advise you on what treatment options are possible you will need to
have more detailed tests to identify exactly which arteries are affected and how
badly. There are two commonly used tests:
Duplex ultrasound is a special form of ultrasound that can look inside the
body and can also "see" the blood moving in the arteries and
veins. It is non-invasive and painless and is done as an outpatient test.
Angiography involves taking x-rays of the arteries and to show them up a special
dye needs to be injected into the artery through a needle. Angiography
produces very good pictures of all the arteries but is a more invasive procedure
and normally you need to be admitted to hospital for a day or so (angiogram).
8. What are the surgical options for treating intermittent claudication?
There are two main options for the surgical treatment of intermittent
Angioplasty is a minor procedure, similar to an angiogram, that does not
require a full anaesthetic and is performed under x-ray guidance.
Angioplasty is only suitable for some types of blocked or narrowed arteries (angioplasty).
Arterial bypass is a major procedure that involves an operation to place a
bypass graft across the blocked artery. Arterial bypass cannot be done
using local anaesthetic. Arterial bypass is reserved for when other
methods are not possible or have failed and where there are severe symptoms (arterial