Advice to patients with intermittent claudication
- What is Intermittent Claudication? The pain you feel in your legs is called intermittent claudication. It is due to reduced circulation caused by narrowing or blockage of the main artery in your leg because of hardening of the arteries (atherosclerosis). Over the years, cholesterol and calcium build up inside our arteries, occurring much earlier in smokers, diabetics, or people with high cholesterol levels or blood pressure. The circulation is sufficient when resting but the leg muscles cannot obtain enough blood for exercise and cramp occurs which is eased by resting. The pain comes on more rapidly with more vigorous exercise, such as walking quickly or going uphill.
- How can I help myself? The blockage will never clear itself but the situation can improve due to opening up of smaller arteries (collateral circulation) which carry blood around the block, often within six to eight weeks of the onset of claudication. There are several things you can do which may help, the most important are stop smoking, take regular exercise and lose weight.
Smoking: if you are a smoker you must make a sincere and determined effort to give up completely. Tobacco is harmful on two counts: firstly, it speeds up the hardening of the arteries which is the basic cause of the trouble and secondly, smoking clamps down the small collateral arteries and reduces the amount of blood and oxygen to the muscles. The best way to give up smoking is to choose a day when you are going to stop completely rather than trying to cut down gradually. If you do have trouble giving up, please ask your doctor who can give you advice on nicotine gum and patches or put you in touch with a support group.
Diet: it is very important not to be overweight because the more weight the legs have to carry around, the more blood they will need. Your doctor or dietician will give you advice regarding a weight-reducing diet. If your blood cholesterol is high, you will need a low fat diet and may also require cholesterol lowering drugs.
Exercise: there is good evidence that people who take regular exercise, walking at a steady pace until stopped by the pain, then continuing again when the pain disappears, develop better collateral circulation. Try to walk a little further each day and you should find that the distance you can manage without pain slowly but steadily increases.
- What about treatment? Further treatment may be necessary if your symptoms are severe or do not improve with exercise but most people do not require surgery. An X-ray of the arteries (arteriogram) is usually needed first to see what can be done. Many diseased arteries can be stretched open with a balloon (angioplasty) under local anaesthetic in the X-ray department but sometimes a bypass graft using a plastic tube or vein from the leg is needed. This is a major operation under general anaesthetic and involves being in hospital for about a week. The decision about surgery is usually one for you to make yourself after your specialist has explained the options and the risks involved. More detailed information about these procedures is available.
- Do drugs help? Although there are quite a number of proprietary tablets and drugs on the market, there is very little evidence that any actually help-drugs will not unlock the artery. Your doctor may have already tried drugs in your case-so you can judge for yourself. Aspirin is often prescribed because it may slow down the hardening of the arteries a little.
- What is the risk of losing my leg? Very few patients (around 1%) with intermittent claudication end up with an amputation and your specialist will make every effort to avoid it.
The most important thing is that you improve your lifestyle
keep walking, lose weight and stop smoking!