Claudication

Claudication refers to the pain, aching or fatigue of the muscles of the buttocks, thigh and/or calf that occurs with exertion. This pain or cramping is caused by poor circulation due to blockage of the arteries of the lower extremity.

Nearly 9 million people, or 12 percent of the U.S. population, experience occasional claudication. This increases to 20 percent in people over the age of 70.

Claudication may occur in one or both legs, depending on where the blockage occurs. The pain is brought on by walking or exercise and disappears with rest. Claudication can range from being a mild nuisance to a disabling limitation.

Claudication is caused by atherosclerosis in the lower extremities is known as peripheral arterial disease (PAD). Atherosclerosis is the hardening and narrowing of the arteries over time through the build up of fatty deposits, called plaque, along the artery walls. As plaques grow, they increasingly block the flow of blood through the arteries.

Artery blockages that cause claudication may be in the abdomen, pelvis, groin, thigh and/or the calf.

PAD is a risk factor for heart attack and stroke. A major treatment focus is to prevent these serious complications. Claudication can progress into the more severe critical limb ischemia. The aggressiveness with which it is treated will depend on the degree to which the claudication is interfering with the patient’s lifestyle.

PAD symptoms may include:

• Pain in the buttocks, thigh and/or calf, occurring with walking
• Tired or burning sensation in the buttocks, thigh and/or calf with walking

Risk factors for claudication are the same as those for atherosclerosis, hardening and narrowing of the arteries due to the buildup of fatty deposits called plaque:

• Age
• Smoking
• Diabetes
• Overweight or obesity
• Sedentary lifestyle
• High cholesterol
• High blood pressure
• Family history of atherosclerosis or claudication

Your doctor may identify and locate the cause of claudication using one or more of the following methods:

• Auscultation: The presence of a bruit, or “whooshing” sound, in the arteries of the legs is confirmed using a stethoscope.
• Ankle-brachial index (ABI): The systolic blood pressure in the ankle is divided by the systolic pressure at the arm.
• Doppler ultrasound: This form of ultrasound can measure the direction and velocity of blood flow through the vessels.
• CT angiography: An advanced X-ray procedure that uses a computer to generate three-dimensional images of blood vessels.
• Magnetic resonance angiography (MR angiography): The patient is exposed to radiofrequency waves in a strong magnetic field. The energy that is released is measured by a computer and used to construct two- and three-dimensional images of the blood vessels.
• Angiogram: An X-ray study of the blood vessels using contrast dyes.

Treatment for claudication usually focuses on the reduction of risk factors associated with atherosclerosis:

• Smoking cessation
• Walking, usually 30 minutes a day
• Medication and lifestyle changes aimed at reducing cholesterol, blood pressure and blood-sugar levels
• Medication, such as aspirin, to prevent heart attack and stroke
• Medication to improve walking distance, such as cilostazol (Pletal)
• Diet low in saturated fats

Endovascular treatments

Minimally invasive endovascular treatments may be recommended if claudication interferes with a patient's work or lifestyle, and if the diseased arteries are likely to improve with such treatment. The Vascular Center has the full complement of endovascular options available. The option recommended depends on the location and severity of the arterial blockages. In general, insertion of a catheter through a needle puncture, under local anesthesia, into the arteries of the groin will allow access to the diseased portion of the artery. Some of the endovascular procedures used to treat claudication include:

• Angioplasty: A tiny balloon is inserted through a puncture in the groin. The balloon is inflated using a saline solution one or more times to expand the narrowed or occluded artery.
  • Cutting balloon: A balloon imbedded with micro-blades is used to dilate the diseased area. The blades cut the surface of the plaque, reducing the force necessary to dilate the vessel.
  • Cold balloon (CryoPlasty): Instead of using saline, the balloon is inflated using nitrous oxide. The gas freezes the plaque during the dilatation. The procedure is easier on the artery; the growth of the plaque is halted; and little scar tissue is generated.
• Stents: Metal mesh tubes are expanded and left in place to provide scaffolding for an artery that has been opened using a balloon angioplasty.
  • Balloon-expanded: A balloon is used to expand the stent. These stents are stronger, but less flexible.
  • Self-expanding: Compressed stents are delivered to the diseased site. They expand upon release and are left in place to hold open the artery. These stents are more flexible.
• Laser atherectomy: Small bits of plaque are vaporized by the tip of a laser probe.
• Directional atherectomy: A catheter with a rotating cutting blade is used to physically remove plaque from the artery, opening the flow channel.

Recovery from these procedures takes one or two days, and most of these procedures are done on an outpatient basis.

Surgical treatments

Patients who are severely limited by their claudication, but are not good candidates for minimally invasive endovascular procedures, may be given the option of surgical treatment. This treatment often involves bypass around the diseased segment with either a vein from the patient or a synthetic graft. Hospitalization after a bypass operation varies from a few days to more than a week. Recovery from surgery may take several weeks.