Information for patients with intermittent claudication
This leaflet tells you about a condition known as intermittent claudication; it explains what the condition is and describes the different treatment options. There are separate more detailed leaflets about the radiological procedure and surgical operations available. This leaflet is not meant to replace the information discussed between you and your doctor, but can act as the starting point for such a discussion or as a useful reminder of the key points.
What is intermittent claudication?
This is a cramp-like pain in the foot, calf, thigh or buttock brought on by exercise and which occurs after walking a certain distance. It is usually caused by “hardening of the arteries”, a narrowing or blockage to the main arteries in your legs due to fatty deposits lining the artery walls which builds up over the years (atherosclerosis). People who smoke, are diabetic, have high blood pressure or have high cholesterol level are more prone to this condition. Pain is caused by reduced blood supply to the muscles due to the narrowing or blockage. The circulation is sufficient when resting but the leg muscles cannot obtain enough blood for exercise and pain occurs, which is eased by resting. The pain comes on more rapidly with more vigorous exercise, such as walking quickly or going up a hill, if the condition becomes more severe it may lead to pain in the feet and toes at rest. Ulcers and gangrene may develop in a small percentage of people. Amputation is rare in patients with intermittent claudication but can be a consequence of this condition. The blockage will never clear itself but the symptoms improve as smaller branches open up to carry blood around the blockage. This is called a collateral circulation.
The natural history of claudication is that:
- 75% of patients will have no change to their condition. It may slightly improve with time and exercise.
- 25% will have some deterioration, 5% of which will develop a severe problem where 2% of this subgroup will lose a leg.
- In general it is better NOT to directly interfere with the arteries for treatment.
What can I do to help myself?
Modifications to your life style will prevent your symptoms from worsening.
There are three main aspects that need to be addressed. These are:-
- Smoking- if you are a smoker you MUST STOP as tobacco speeds up the blockage of your arteries and also affects the development of the collateral circulation which is trying to increase ye blood circulation to your legs. Help is available for you to QUIT.
- Low fat diet-reducing the amount of fat in your diet will help to reduce your blood cholesterol which in turn will help to reduce the amount of fat deposited in your arteries. You may also require drugs to lower cholesterol. Foods that are high in fat include dairy products, red meat, biscuits, cake ,crisps etc. you will need to eat more fish, chicken, turkey, cereals, fruit and vegetables. It is advisable to rethink how you cook your food. Grilling, steaming and baking are preferable to frying or roasting food in oil. If you are overweight, it is advisable to try and reduce your weight, because the more weight your legs have to carry the more blood they will need and the more pain you will suffer.
- Regular 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 a better collateral circulation. Try to walk a little further each day and you will find that the distance you can manage without pain slowly but steadily increases. Exercise will only benefit your symptoms if continued over a period of time, preferably forever.
Your treatment will be planned depending on the severity of your symptoms and how it is affecting your quality of life. In most cases you will start with a conservative plan of treatment with more exercise and be encouraged to walk through the pain to build up the collateral circulation. The diagram below shows how the collateral vessels develop. Providing you have no history of stomach ulcers, you will be prescribed a low dose (75 mg) of soluble aspirin or other drugs which reduce the chances of more trouble with your circulation.
Are there alternative treatments?
If the symptoms do not improve or are affecting your lifestyle greatly a different line of treatment may be undertaken. This is a scan or x-ray of the arteries using a dye to highlight where the blockage is and the extent of it (angiogram). Short blockages can be stretched open with a balloon; this is called an angioplasty and requires an overnight stay in hospital. Longer blockages may require surgery in the form of a bypass operation. This is using a plastic tube or vein from your leg to bypass the blood flow around the blockage. If you need surgery the type of operation will be fully explained by your surgeon. All intervention to arteries carries risk.
Is the treatment safe?
Very few patients with intermittent claudication end up with an amputation. The most important thing is that you improve your lifestyle and keep walking, change your diet, lose weight and STOP SMOKING! The simple exercise program is very successful at increasing walking distance. It provides a long term solution for the majority of people and most importantly it is safe. Surgery and to a lesser extent angioplasty is not always successful and can only be justified for a leg that is threatened by very poor circulation (usually the pain is keeping you awake at night, or ulceration or gangrene of the foot or toes). Claudication is neither limb nor life threatening and it is not necessary to treat with angioplasty or surgery if the symptoms are mild.
Will I have to come back to hospital?
As an outpatient your progress may be monitored by the vascular nurse specialists in their clinics. The frequency of attendance will be determined by your individual condition and symptoms. Alternatively you may be referred to an exercise class to help the collateral vessels develop.
Some of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about your condition.