Claudication

Claudication itself is a symptom, not a diagnosis. However, a person suffering from claudication may feel a range of sensations because of the occluded blood vessel. These include: 

• Fatigue in the legs while walking
• Burning sensation in the legs while walking
• Pain on continuous walking
• Cold feet
• Limited walking distance
• Impaired balance
• Substantial relief from pain upon resting 

Based on the onset and symptoms associated with it, claudication can be classified into three categories:

• Mild claudication: When a person can walk up to 900 feet before cautiously stopping
• Moderate claudication: When a person is able to walk 600 feet before being forced to take rest
• Severe claudication: When a person can walk less than 300 feet before they have to stop because of the pain

Any pathological condition which has the potential to impede the flow of blood to the lower extremities is a possible risk factor for claudication. Claudication is usually a sign of an underlying condition like:

• Peripheral arterial disease: A circulatory disorder affecting blood flow to the peripheral arteries
• Atherosclerosis: Restricting the blood flow through-hardened fatty deposits in the arterial wall
• Thromboembolic obstruction: Formation of a blood clot in the blood vessels
• Thromboangiitis obliterans (Buerger's disease): Long-standing inflammatory disease leads to the formation of blood clots in the peripheral vasculature
• Polyarteritis nodosa: Inflammation of small- or medium-sized blood vessels, which obstructs blood flow to respective muscles or organs

The severity of claudication experienced by an individual depends directly on the location, extent and rate of development of arterial obstruction rather than the disease which causes it.

Other than the causative factor, there are various risk factors which aggravate the progression as well as the occurrence of claudication. The most significant among these are:

• Smoking
• Diabetes
• Obesity
• Increased cholesterol levels
• High blood pressure
• Sedentary lifestyle
• Family history of atherosclerosis or claudication
• Old age (men older than 55, and women over 60 years are more prone)

For making a diagnosis of claudication, the patient’s history is the first and foremost tool. The doctor will ask several questions regarding the onset, severity, location and, most importantly, the reproducibility of pain with exercise and the rest time required to get substantial relief.

In order to reach a definitive diagnosis, your doctor may advise tests like pulse reading through oscillometer and affirming blood supply by arteriography.

Usually, if the blockage occurs slowly enough, the body creates microchannels to manage adequate blood flow to the leg. If, however, the condition develops very quickly or in multiple blood vessels, it leads to claudication which can be very painful.

Pain management is possible by numbing certain ganglia (collection of nerves) near the spine (paravertebral area), by injecting phenol, alcohol or procaine. Extirpation of lumbar ganglions at the nerve supply to the concerned muscle can also reduce the pain sensation arising from claudication. However, these techniques only serve to ease the pain and do not address the underlying problem, which is the blockage.

Management of claudication depends on the extent of the disease. In mild to moderate cases, certain exercises can improve function as well as the quality of life significantly. The gold standard in workouts for intermittent claudication is a programme of supervised walking exercise therapy. This three-month programme is performed under the guidance of a professional and includes episodes of walking and resting. Gradually, the patient is asked to increase the duration as well as the intensity of the walks. This exercise programme can improve the functional capability of a claudicated individual to a large extent. Other exercises which can be beneficial for claudication in the leg and arm are ergometry, pole striding and resistance training.

Medication and supplements like calcium and vitamin E tablets, theobromine, cytochrome C, depropanex, and intravenous hypertonic saline solution can also ease the symptoms. 

Mechanical aids can also help to improve vascular supply to the localised area. One such aid is mechanical compression device - it works by putting intermittent non-pneumatic pressure on the calf muscles, to stimulate blood circulation to the affected body part.

In severe cases of claudication, surgical interventions have shown promising results. Examples include femoral vein ligation (tying) followed by anastomosis (joining) with femoral artery - to bypass the blockage in the legs and restore circulation to the extremities. Nowadays, replacement of occluded blood vessel by grafts is also emerging as a remedy for claudication. 

Direct intervention at the site of obstruction can also prove beneficial. It is usually attempted by periarterial stripping (removing a thin layer of arterial wall circumferentially from inside using an operating microscope). 

Angioplasty can help to restore adequate blood supply to the vessels in the legs and hands. It is a percutaneous procedure where the cardiologist makes a small incision to insert a catheter, and then a balloon-like device into the vessel. “Inflating” this balloon slightly helps to push the plaque or cholesterol against the walls of the vessel and open up the passage for blood to flow. If necessary, the cardiologist may even suggest putting a stent in to prevent blockage in the same area again. It is a minimally invasive procedure where the patient can start walking after two days of stenting procedure or angioplasty and back to the normal life just after one or two weeks of the interventional procedure.