Intermittent claudication is characterized by an aching, crampy, tired, and occasionally burning pain in the legs that appears and disappears. This discomfort usually arises while walking and subsides with rest, owing to reduced blood flow in the leg arteries. In severe cases, the pain can persist even at rest. It may affect one or both legs and tends to worsen progressively. Some individuals only report leg weakness or a sense of "fatigue" in the buttocks during walking. This condition is more commonly reported in men.The intermittent nature of the pain is attributed to the narrowing of arteries supplying blood to the legs, which limits oxygen delivery to the muscles. This shortage is particularly noticeable when the muscles' oxygen demands increase during exercise. Intermittent claudication can result from temporary artery constriction due to vasospasm, permanent narrowing, or complete blockage of a leg artery. This condition is relatively prevalent, affecting men more frequently than women. It impacts 1-2% of people under 60, 3-4% of those aged 60 to 70, and over 5% of individuals older than 70.A clinical examination assesses the pulses in the legs and feet. Diagnostic tests include comparing blood pressure in the arms and legs, Doppler ultrasonography on the legs, duplex Doppler/ultrasound exams to observe arterial blood flow, and arteriography, which involves injecting dye into the arteries for visualization.The prognosis for intermittent claudication is generally positive, as the condition often stabilizes or improves over time. Conservative treatments are recommended. Regular walking can help extend the distance a patient can walk without experiencing symptoms. A daily walking regimen that involves resting during pain or cramping can enhance functionality by promoting the growth of collateral circulation, which is the development of new small blood vessels bypassing the arterial blockage. It is crucial to quit smoking and avoid applying heat or cold to the legs and wearing tight shoes.Two medications are available to manage intermittent claudication: pentoxifylline (Trental) and cilostazol (Pletal). These drugs work differently; Trental reduces blood viscosity, improving its flow to the legs, while Pletal dilates the arteries by inhibiting the enzyme phosphodiesterase III and also decreases blood clotting.If conservative measures prove insufficient, correcting the arterial narrowing may be considered. This decision depends on the location and severity of the narrowing and the patient's overall health. Surgical options like bypass grafting or procedures such as balloon angioplasty may be used to alleviate the condition and relieve pain when claudication is severe and persistent.The term "claudication" is derived from the Latin "claudicare," meaning to limp. There is also venous claudication, which results from inadequate venous drainage.
