Cardiovascular system Claudication

Claudication is a term used to define the pain, tiredness, or weakness feeling in the legs that occurs during an exercise (walks). The symptoms begin after a specific distance, improve with some rest minutes and, after that, the patient is able to course over the same previous distance until he/she has to stop again.

It more often occurs in legs, but it can also occur in arms. The symptoms are due to the obstruction of the arteries that take blood to the legs (iliac arteries). This process is due to the atherosclerosis, which is a process of artery aging, where atheroma (fat) plaques form inside the arteries as the time passes. With such plaques, the vessel reduces its internal diameter, causing difficulty for the blood passage.

Figure 1. Iliac artery with atheroma plaque

The arteries usually take oxygen-rich blood until the muscles. When such arteries become obstructed, the blood flow to the muscles is reduces. Muscles need more blood during an exercise and, as the vessels are compromised, there is an ischemia (reduction in blood flow), causing pain. The pain may occur at rest in more severe cases.

The diagnosis is usually made by a simple physical exam of the patient, where a decrease in or lack of arterial pulses in the lower limbs is detected by palpation. A pressure measurement by comparing arm to leg can be useful. Complementary exams such as echodoppler, angiotomography, or arteriography are usually only needed when it is intended to intervene and are more useful as procedure planning. The diagnosis is clinical.

The treatment is initially clinical, and the procedures must be reserved to patients with very limiting claudication (few meters), which impair the quality of life, and that did not respond to the initial treatment. The great majority of cases improves a lot with modifications in lifestyle, mainly with exercise and medication.

Intervention-Procedure

An intervention may be necessary in some cases, and there are two possible forms: angioplasty or surgery.

In an angioplasty, a balloon is placed inside the vessel and the narrowing is dilated, and it can or cannot be associated to a stent.

Figure 2. Angioplasty and stent inside an artery

A bypass (by saphenous vein or prosthesis) is performed in the surgery. This is a kind of surgery where a bypass is made over the narrowed or obstructed place, so improving the blood and oxygen flows.

Figure 3. Coronary artery bypassed in a leg

Treatment

Physical exercise is the initial and most important treatment. It must be individualized for each case. The walks must be performed until the pain time. When the patient presents pain, it should stop for some minutes and walk again until the symptoms restart. The more times it is repeated, the better will be. The improvement occurs slowly (from 3 to 6 months). With time, the exercise helps to develop more blood vessels (collateral circulation), so improving the claudication symptoms and distance.

But some medicines are also an important support to the physical exercise to help to improve the claudication distance and can be used in specific cases. Measures that can be taken to keep the vessels healthy:

– avoid smoking;
– regular physical exercise;
– treat diabetes;
– treat high pressure;
– keep low cholesterol;
– healthy diet – low in saturated fat and calories;
– keep an ideal weight.

Support notes

Echodoppler: Exam that uses ultrasound and Doppler effect to verify the blood flow in the vessels, so helping to identify problems in valves and to measure pressure. Click here to go to the page of Echocardiogram and to know more about this subject.

Angiotomography: Exam that uses Rx and a computer to record detailed artery images. Click herei to go to the page of Angiotomography and to know more about this subject.

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