Intermittent claudication: causes and symptoms

Intermittent claudication is pain in the legs due to poor circulation. Discover its symptoms, causes and treatments to improve circulation.

Intermittent claudication is like a distress signal that our legs send when they do not get enough blood during exercise. It’s a pain that is noticeable when walking and goes away when standingas if the body said: “leave me, I can’t take it anymore.” This symptom constitutes a manifestation of peripheral arterial disease (PAD), a circulatory disease in which the arteries in the extremities (usually in the legs) narrow and not enough oxygen reaches the muscles. Although many people attribute it to fatigue or “age,” intermittent claudication is a subtle sign that can reveal vascular problems unrecognized for years.

Main symptoms

The most common symptom is pain in the muscles when walking a certain distance. It is not sharp, but rather crampsheaviness and fatigue that force you to stop. The most frequent thing is that the pain is localized in the calvesbut if the obstruction is higher, the thighs or even the buttocks may hurt.

Some other signs that may accompany this picture are:

• colder feet than normal.
• Pale skin or slow growing nails.
• Wounds that take time to healsomething that despairs those who suffer from them.

In more advanced stages, the pain occurs even at rest, especially at night. When it occurs, it is often a warning sign.

Why does it arise?

The most common is atherosclerosis, a process in which fat deposits, calcium, accumulateor… together with other substances in the wall of the arteries. It is a silent disease: it progresses slowly and when it shows its face, there is already a certain degree of obstruction.

In addition to atherosclerosis, there are other less common causes:

• Vasculitis or inflammatory vascular diseases.
• Arterial compression by neighboring anatomical structures.
• Congenital anomalies.
• Sudden clot blockages, causing more sudden symptoms.
• Association with other diseases

And sporadic surrender rarely comes alone. It is often associated with other cardiovascular diseases. A patient with PAD is more likely to have:

• Ischemic heart disease (angina, heart attack).
• Cerebrovascular disease (stroke).
• Aneurysms, especially of the abdominal aorta.

In fact, many times the PAD is a “window” to see what is happening in other parts of the circulatory system.

Risk factors

When the risk factors for developing intermittent claudication are analyzed, the same characteristic is quickly identified: most are modifiable factors, related to lifestyle and other chronic diseases. The most important ones are:

• Smoking, the main cause.
• Diabetes mellitus, especially if it is not controlled.
• Arterial hypertension.
• High cholesterol.
• Sedentary lifestyle and overweight.
• Advanced age, although cases are increasingly being seen in younger people.

And manipulating these factors is not only possible, it can change the course of evolution.

Possible complications

Time left untreated can cause serious complications. Among the main ones are:

• Pain at rest: more severe ischemia.
• Ulcers on the feet or legs that are painful and slow to heal.
• Gangrene, especially in poorly controlled diabetics or inveterate smokers.

Additionally, and this sometimes surprises patients, intermittent claudication is associated with an increased risk of myocardial infarction or stroke.

Diagnostic tests

The diagnosis is generally simple. It begins with a complete medical history and a physical examination, in which the doctor palpates the pulses in the legs. From there, different specific tests are usually used:

• Ankle-brachial index (ABI): A simple, quick and painless test. Compare the blood pressure in the ankle with that in the arm. When the result is low, it strongly suggests PAD.
• Arterial echo-Doppler: Makes it possible to “see” the blood through the arteries and determine the point of obstruction.
• CT angiography or MR angiography: They provide very detailed images, which can be useful for planning an intervention if necessary.
• Arteriography: It is the most accurate test, but it is not always used. It is usually indicated in complex situations or when surgical or invasive treatment is considered.

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Available treatments

Treatment involves lifestyle changes, medications, and, in some cases, procedures to improve blood flow. Treatment aims to relieve symptoms and prevent the disease from progressing.

Change of habits

• quit smoking. There is no better advice than this.
• Walk 30-45 minutes several times a week, ideally in supervised programs.
• Have well controlled glucose, blood pressure and cholesterol.
• Follow a heart-healthy dietlike the Mediterranean, rich in fruits, vegetables, legumes and fish.
• Sometimes patients report that, after several weeks of regular walking, they can cover distances that at first seemed unattainable. And that’s always a good sign.

Pharmacological treatment

• Antiplatelet agents (aspirin, clopidogrel) in global cardiovascular prevention.
• Statins, which help stabilize atherosclerotic plaques.
• Specific medications such as cilostazol, which in some patients clearly increases the distance they can walk without pain.

Interventional treatments and surgery

• When pain interferes with daily activities or there is a risk of severe ischemia:
• Angioplasty, with or without stent.
• Arterial bypass: creates an alternative route for blood.
• Endarterectomy, in which the plaque that is causing the blockage is removed.

Intermittent claudication is not just pain when walking, but an opportunity to discover vascular disease in time. Identifying your symptoms, consulting early and acquiring healthy habits can make a difference in the prognosis and, above all, in the quality of life. And taking care of circulation is not just taking care of your legs… it is taking care of your heart and your future.

What you should know…

• Intermittent claudication is a symptom of peripheral arterial disease (PAD), characterized by pain or cramps in the legs when walking due to a lack of blood flow that improves with rest.
• Its main cause is atherosclerosis, although there are other less common causes, and it is associated with a higher risk of cardiovascular diseases such as heart attack, stroke and aneurysms.
• Its diagnosis is accessible and treatment combines lifestyle changes, medication and, in severe cases, interventions, with special importance in stopping smoking, walking regularly and controlling risk factors such as diabetes, hypertension and cholesterol.

Literature

• MedlinePlus. Peripheral arterial disease. Available at: Medline Plus