Intermittent claudication

Definition

Intermittent claudification, medical correct term peripheral arterial disease, is caused by arteriosclerosis and causes circulatory disorders in the legs, in some rare cases also in the arms. The consequence: when strenuous activity the muscles are not provided well enough with oxygen anymore.

Symptoms

The guiding symptoms of the intermittent claudication are pain in the legs, especially when walking. That sounds bothersome but not too dramatic. That is why the affected people often do not take the disease serious. That is a mistake: an intermittent claudication increases extremely e.g. the risk of a coronary heart disease, a cardiac infarction or a stroke. Because all those illnesses are caused by vessel calcifications.

The peripheral arterial disease does not show medical conditions at the beginning. At an advanced stage the pain can be so severe that the patient can only move in a wheelchair. Often there are also several open wounds on the leg and the foot that rarely heal. These ulcers have a high risk of infections why an amputation might be necessary in some cases.

Diagnosis

With the double sonography, an ultrasound practice, the blood pressure at the ankle or at the upper arm can be estimated. Is the blood pressure lower at the ankle than at the arm this approves an occlusive arterial disease of the legs.  In addition to this examination there will be a load test (treadmill).

With the double sonography it is also possible to find out where and how many constrictions (stenosis) there are. The double sonographie can replace also the angiography in many cases.

In case there is a need for further therapy (balloon stretching, bypass surgery) an angiography is usually necessary.  This means the imaging of the arteries with the help of X-ray technology which requires the injection of a contrast medium with a vessel catheter before the actual examination. Constrictions (stenosis) in the vessels can become visible in the X-ray image by that.

Therapy

For the intermittent claudication there are a couple medical options for therapy, medication, bypass surgery and balloon stretching. But these treatments only have a long-term effect if the patient changes his life style. The most important step is to quit smoking since the consume of nicotine is the no 1 risk factor for a peripheral arterial disease.

The intermittent claudication has more severe consequences the more advanced it is. The mobility decreases a lot because of the strong pain; amputation might be necessary in very severe cases because of more and more non healing wounds at the legs and the feet.

This is the reason why the exercise of walking is the most important therapy for a patient with intermittent claudication. Movement increases the pressure with which the blood is pushed through the vessels so that new small blood vessels (collaterals) develop at constricted passages. The medical effect of walking exercise is proven by now.

There are also several ways to treat intermittent claudication with medication. The preset therapy are 100mg  acetylsalicylic acid (ASA) daily. The therapy with medication depends on the risk factors of the patient. With increased amounts of fat in the blood- LDL cholesterol- cholesterol-lowering-drugs should be taken. High blood pressure and diabetes also need an optimal treatment. The therapy with Cilostazol. It can help patient with a decreased mobility to increase their mobility and to improve there quality of life.

When there is a vascular dilatation balloon catheter is launched into the constricted artery under the X-ray control and with local anaesthesia and enlarged there. If necessary an additional vessel stilt can be build in to avoid another constriction of the artery. In many cases this procedure can be performed as an in-patient.   

Severe closures of vessels that can not be treated with a catheter procedure can be treated with a bypass surgery. This procedure takes place with general anaesthetic and can only be performed on stationary patient.