Aging Begins at 30

Intermittent Claudication

Ian Maclean Smith, M.D.
Emeritus Professor
Department of Internal Medicine
University of Iowa Hospitals and Clinics
Creation Date: March 2003
Last Revision Date: March 2003
Peer Review Status: Internally Peer Reviewed

Intermittent claudication affects 9 million people in the United States or about 12% of the population or 20% of those over 70. It interferes with daily activities and is present in about a quarter of the people who have hardening of the arteries (arteriosclerosis) in the legs. It can be associated with other arteriosclerotic vessel problems such as heart attacks or the tendency to have strokes, so it may be a wake-up call to treat these associated abnormalities. Arteriosclerotic leg disease is increased in individuals with diabetes, high cholesterol, high blood pressure and in smokers. In some cases, when using the stethoscope, noises can be heard over the partial blockage. The skin can get shiny, lose hair or ulcerate. If you have nerve disease pain, as in diabetes, it will make it worse.

Claudication can be diagnosed by finding a difference between the blood pressure taken at the arm and at the ankle. It can further be defined by using a Doppler device, which shows the passage of blood like the swish-swish of passing trains. If surgery is contemplated, injected dye, or magnetic resonance imaging can outline the blockages of the vessels in detail. Blockages are most common at branch points in the blood vessels with increased turbulence. They can be multiple. About 30% have the blockage in the aorta; in the abdomen or in the groin, in the thigh or behind the knee in 85%; and more peripheral blood vessels in 45%.

The treatments that can be used are exercise on a treadmill for 40 minutes 3 to 5 days a week. Certain drugs can lessen the friction of the blood and other drugs can lessen the arteriosclerotic effect of high cholesterol. High blood pressure should be controlled. Vasodilators (blood vessel expanders) and anticoagulants don't help. Lastly angioplasty (catheter surgery of blood vessels) or open leg surgery with possible replacement of worn out blood vessels with artificial knitted Dacron replacements can be performed. Operative mortality is about 2%.

It is said that exercise can improve walking time to pain or the distance covered by 100 to 200%. This should be preceded by exercise testing while monitoring the ECG to detect concomitant heart problems.

About 5% to 10% of patients with this type of leg (rarely arm) vascular disease without treatment need amputation. Patients with claudication have a 70% 5-year, and a 50% ten-year survival rate. The outlook is worst in smokers and diabetics.

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See related Patient Topics Bones, Joints and Muscles, Injuries and Wounds, Leg Injuries and Disorders or Muscle Cramps.

See related Provider Topics Bones, Joints and Muscles, Injuries and Wounds or Muscle Cramps.

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