Claudication (patient information)

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Overview
Claudication is not a disease, but a symptom. It results from insufficient blood flow to a certain part of the body, particularly when exercising. It usually affects blood vessels in the lower limbs, although it sometimes occurs in the arms. Claudication is a painful condition.

What are the symptoms of Claudication?
Symptoms of claudication may include:
 * Pain while engaging in rigorous activity. Pain may occur in:
 * Buttocks
 * Hips
 * Thighs
 * Calves
 * Feet
 * Arms
 * Pain that is stop-and-go during moderately rigorous activity
 * Weakness
 * Aching or burning sensations
 * Some men may experience impotence

For more severe cases of claudication, you may also experience:
 * Pain while sitting or lying down
 * Extremities that are bluish in color, and may feel cold when you touch them
 * Ulcerations or sores on your extremities or lower legs.

What causes Claudication?
Claudication is typically caused by peripheral artery disease, a disease in which a person’s arteries in his limbs are damaged. The artery damage is usually caused by atherosclerosis.

Atheroschlerosis occurs when arteries become blocked by atherosclerotic plaque, which is usually made up of fat and cholesterol. This plaque causes arteries to become rigid and constricted, which can restrict the blood flow through them.

Since arteries carry oxygen to your muscles, this can be a serious problem. The pain from claudication occurs because not enough oxygen is reaching your muscles.

Who is at highest risk?
People with the following characteristics are at higher risk for developing both claudication and atherosclerosis:
 * Smokers
 * High blood pressure
 * Body mass index over 30 (obesity)
 * Total blood cholesterol over 240 mg/dL (6.2 mmol/L)
 * Diabetes
 * Age over 70 years
 * Age over 50 years if you have diabetes or you smoke
 * A family history of:
 * Claudication
 * Atherosclerosis
 * Peripheral artery disease

When to seek urgent medical care?
If you have pain in your limbs when you exercise, see your doctor. Claudication and peripheral artery disease can be serious, and may affect your quality of life if they are not treated.

Diagnosis
Your doctor will ask you to provide your medical history, and will complete a physical exam to diagnose you. Your doctor will want to rule out other conditions that may be causing you pain. The following are tests that your doctor may use to diagnosis claudication:
 * Checking your pulses in your feet
 * Ankle-Brachial index— this checks the blood pressure in both your ankles and arms to compare the two.
 * Doppler ultrasound to monitor your blood flow
 * Magnetic resonance imaging (MRI) or computed tomography angiography (CTA) to determine if your blood vessels are damaged.

The pain in your legs could be due to another condition, such as spine, joint or muscle problems. Your doctor can make a diagnosis based on your symptoms and a medical history, physical exam and appropriate tests.

Other conditions besides from claudication can cause similar symptoms. Such conditions include:
 * Deep venous thrombosis
 * Spinal stenosis
 * Musculoskeletal conditions
 * Peripheral neuropathy

It is important to see your doctor so that s/he can provide an accurate diagnosis.

Treatment options
Treatment is important for both claudication and the underlying conditions. Treatment can include simply engaging in lifestyle changes to stay healthy. Healthy lifestyle choices that are especially important for someone affected by claudification include:
 * Not smoking. Smoking puts you at high risk for peripheral artery disease, and increases the chances that your condition will worsen.  Also try to eliminate your exposure to secondhand smoke.
 * Exercising regularly. This will keep your muscles in shape and teach them to use the oxygen they get more effectively.  Although exercise may be painful at first, an exercise program that is designed and supervised by a healthcare professional can improve your symptoms and help you maintain mobility.
 * Keeping your cholesterol levels healthy. Get your cholesterol checked, and follow your doctor's recommendations to keep your levels in a normal range.  This may include medications and a balanced diet filled with fruits, vegetables, legumes, and grains, while keeping fat intake low.
 * Don't take medications that constrict blood vessels. These include cold medications and sinus medications that contain pseudoephedrine.  Ask your doctor which over-the-counter medicines may be harmful to you.
 * Be careful not to hurt your legs or feet. Since your legs and feet are not getting enough oxygenated blood, injuries are more likely to develop complications.  Make sure to wear suitable, protective shoes that fit you well if you are doing something that may injure your feet.

Treatments include:
 * Medication, such as aspirin, anti-clotting drugs, drugs to improve blood flow, and/or drugs to help lower your cholesterol.
 * Angioplasty for more serious cases. An angioplasty is an invasive procedure that widens clogged or damaged arteries.
 * Vascular surgery to replace damaged blood vessels with healthy blood vessels from a different place in your body. This procedure creates a way for blood to flow around the blockage in your artery.
 * Hyperbaric chamber treatment to heal ulcers if you have ulcers due to claudication. The high-oxygen chamber is good for promoting healing.

Where to find medical care for Claudication?
Directions to Hospitals Treating Claudication

What to expect (Outlook/Prognosis)?
With proper treatment, many people are able to stay active without experiencing pain. However, it is important to maintain a healthy lifestyle to prevent your condition from worsening.

Possible complications
In rare cases, your circulation may become so restricted that the condition is painful even at rest. In these cases, your limbs may feel also feel cool to the touch. This can be dangerous since healing in the affected areas will be hindered. Ulcers or skin injuries will be more susceptible to developing gangrene and may require amputation. However, such cases are rare. Smoking increases the risk of your disease progressing to the point of amputation.

Prevention
Maintaining a healthy lifestyle is the best method of prevention.
 * Don't smoke. Quit if you do smoke.  Try to avoid second hand smoke.
 * Maintain a healthy body weight.
 * Keep your diet low in saturated fats.
 * If you have diabetes, maintain healthy blood sugar levels.
 * Keep your cholesterol levels and blood pressure healthy.
 * Exercise regularly.