Claudication

Claudication is pain felt in the legs during walking.  The symptoms typically begin when you start to exercise and go away a short time after you rest. 

Causes of claudication
Claudication is caused by the arteries in your legs not receiving enough blood and oxygen.  This happens because the arteries in your legs may be narrowed or blocked.  In most cases, the cause of this blockage is atherosclerosis.  Because atherosclerosis may occur throughout the body and not just in the legs, it is critical to diagnose claudication—as it may predict an increased risk for other diseases caused by atherosclerosis—such as heart attack and stroke.

Symptoms of claudication
Some of the typical symptoms of claudication include:

• Discomfort or pain in one or both legs that happens when you walk, and goes away when you rest (also called intermittent claudication)
•  Tightness, heaviness, cramping, or weakness in one or both of your legs with walking.

Risk Factors
Claudication is a symptom of peripheral artery disease (PAD), which is caused by atherosclerosis.
Risk factors for atherosclerosis include:

• Smoking, or a history of smoking
• High cholesterol levels in the blood
• High blood pressure
• Obesity
• Family history of heart or vascular disease

What to Expect at Your Medical Exam

• Your vascular surgeon will try to determine if you have claudication and peripheral artery disease (PAD), and then prescribe the best method of treatment. 
• This evaluation will include questions about the history of your symptoms, including how often they occur, their location and also questions about your general health.
• Your vascular surgeon will also conduct a physical examination, including pulse tests. He or she will feel the pulses at various locations and possibly listen with an instrument called a Doppler. Because atherosclerosis can affect any artery in the body, your vascular surgeon will usually check arteries in other locations in your body besides your legs. 

Diagnostic Testing
After your exam, if your vascular surgeon suspects PAD, diagnostic tests may be performed, which may include:

• Ankle-brachial index (ABI)
• Pulse volume recording, which measures the volume of blood at various points in your legs
• Duplex ultrasound
• Blood tests for cholesterol, high blood sugar or other markers for artery disease
• Magnetic resonance angiography (MRA)
• Computerized tomographic angiography (CTA)
• Angiography

Treatment for Claudication
Based on the results of your physical exam, as well as your diagnostic testing, your vascular surgeon will treat your claudication. 

In most cases, the goal is to address the underlying cause of your PAD, the atherosclerosis. This would include lifestyle modification, such as:

• Smoking cessation
• Weight loss
• Better nutrition
• Medication such as cholesterol-lowering drugs 

Treatment for claudication usually begins with a daily walking exercise program, and occasionally the use of specific medications, which your vascular surgeon may prescribe if appropriate.

In most cases, a walking program and lifestyle modification (the most important is quitting smoking) is all that is needed to improve the symptoms of claudication.  However, if these do not help, or if the symptoms worsen, your vascular surgeon may recommend specific medications, endovascular intervention, or bypass surgery.