Claudication

A diagnosis of claudication and peripheral artery disease is based on a review of symptoms, a physical exam, evaluation of the skin on the limbs, and tests to check blood flow.

Some common tests used to diagnose claudication may include:

• Pulse measurement in your palms or feet to assess blood flow to the entire limb
• Ankle-brachial index, a comparison of blood pressure in the ankles with the blood pressure in the arms
• Segmental blood pressure measurement, a series of blood pressure measurements at different areas on the arm or leg to help determine the amount and location of damage to the arteries
• Exercise testing to determine the maximum distance you can walk or the maximum exertion without pain
• Doppler ultrasound to see the flow of blood
• Magnetic resonance imaging (MRI) or computed tomography (CT) angiography to look for narrowed blood vessels

Symptoms include the following:

• Pain, ache, discomfort or fatigue in muscles every time those muscles are used
• Pain in the calves, thighs, buttocks, hips or feet
• Less often, pain in shoulders, biceps and forearms
• Pain that gets better soon after resting
• The pain may become more severe over time. You may even start to have pain at rest.

Signs or symptoms of peripheral artery disease, usually in more-advanced stages, include:

• Cool skin
• Severe, constant pain that progresses to numbness
• Skin discoloration
• Wounds that don’t heal

Potential risk factors for peripheral artery disease and claudication include:

• A family history of atherosclerosis, peripheral artery disease or claudication
• Age older than 50 years if you also smoke or have diabetes
• Age older than 70 years
• Chronic kidney disease
• Diabetes
• High blood pressure
• High cholesterol
• Obesity (a body mass index, or body mass index (BMI), over 30)
• Smoking

Other complications of peripheral artery disease due to atherosclerosis include:

• Skin lesions that don’t heal
• Death of muscle and skin tissues (gangrene)
• Amputation of a limb

The goals of treating claudication and PAD are to reduce pain and manage the risk factors.

Exercise is an important part of treatment; it reduces pain, increases exercise duration, improves vascular
health in the affected limbs, and contributes to weight management and an improvement in quality of life.

• Recommended walking programs include:
• Walking until you feel moderate pain or as far as you can
• Resting to relieve pain
• Walking again
• Repeating the walk-rest-walk cycle for 30 to 45 minutes
• Walking three or more days a week

Supervised exercise is recommended for beginning the treatment, but long-term exercise at home is important for ongoing management of claudication.

Medications may be used to manage the following:

• Pain
• High cholesterol
• High blood pressure.
• Other cardiovascular risks

Surgery or other procedures
When PAD is severe and other treatments don’t work, surgery may be required. Options include:

Endovascular Procedures including possible angioplasty, atherectomy, or stent. This procedure improves blood flow by widening a damage artery. A surgeon guides a wire and then a device through the blood vessels. The devices may soften the blockage before inflating a balloon and/or placing a stent to keep the vessel open.

Bypass surgery. During this type of surgery, a surgeon takes a healthy blood vessel from another part of the body to replace the vessel that’s causing claudication. This allows blood to flow around the blocked artery.