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(PAD) Peripheral Arterial Disease and Claudication

"Claudication" is a medical term that refers to leg pain while walking that is relieved by rest within a few minutes. It usually occurs in the calf, but can also occur in the thigh or buttocks. It is usually caused by atherosclerotic plaques in the arteries that supply blood flow to the legs. The build up of plaques narrows the arteries and restricts blood flow. This is most noticeable when demand for blood flow is increased during walking.

There are over 2 million Americans who suffer from claudication, including as many as 10% of those over the age of 70 years. Claudication is a chronic, life-style limiting disease--fewer than 20% will progress over 5 years to require interventions to unblock arteries to avoid tissue loss or gangrene. However, claudication is very restrictive of activities usually associated with a satisfying life, and the quality-of life impact of claudication is severe. In fact psychometric studies have shown that claudication decreases patient-reported quality of life similar to other well-know medical conditions such as heart attack and heart failure.

Diagnosis

Claudication is a condition that can usually be readily diagnosed based on the symptoms and simple physical examination findings. Pain in the leg muscles brought on by walking or stair climbing that is reproducible, and relieved within a few minutes of rest, is highly suggestive of the diagnosis. Absence or reduction in pulses in the involved leg is usually confirmatory. A simple noninvasive test, called an "ankle-brachial index" (ABI), can be done to quantify the reduction in blood flow to the leg. This is similar to a blood pressure measurement, but is done on the ankles.

Ankle-brachial indexes and other noninvasive tests can be done in the office of vascular specialists, or increasingly, in the primary care office. There are new generations of ABI machines that are semi-automated and don't require specialized training to obtain accurate ABI measurements. These are increasingly available in primary care offices. For equivocal cases, other tests such as exercise treadmill testing or magnetic resonance may be helpful.

Treatment

Prior to the availability of minimally invasive treatments to open up blocked arteries, most patients with claudication were managed conservatively. That is, they did not undergo surgery to open or bypass arterial blockages--the risk was too great. Recently, new drugs have been developed that are useful for many people, and those with mild disability are often best managed with reassurance, claudication medications, exercise, and global atherosclerotic disease risk reduction.

For those whose activities are hampered by their claudication, interventional procedures like angioplasty and stenting are often done, and can be performed with a small (1/8") incision, often on an outpatient or "short stay" hospitalization (less than one day). The risk of interventional treatments is reduced 90% compared with surgery, and many patients with claudication can have their symptoms relieved with these low risk procedures.

Research

The Vein Institute at Rhode Island Medical Imaging is actively enrolling in the National Institutes of Health CLEVER Study (Claudication: Exercise Vs. Endoluminal Revascularization). This pivotal study of claudication patients will examine and compare the principal treatments for this disease: medications, supervised exercise, and interventional treatments.