Claudication is a term that refers to pain or fatigue in the muscles of the lower extremities, or legs. Most often, this is in the calf region and patients will complain of the pain being aggravated by walking or climbing stairs and relieved by rest. This condition occurs when there is a build-up of cholesterol and fatty material called plaque on the inner lining of the arteries that causes a partial or complete blockage of blood flow to the lower extremities. Because of this blockage of one or more lower extremity arteries there is not enough blood reaching an exercising muscle to meet its energy needs. The pain in claudication occurs with exercise since the blood flow is inadequate to remove the body's waste materials after an activity, such as walking or climbing stairs.

Risk Factors for developing Intermittent Claudication

• Smoking
• Obesity
• Diabetes
• High blood pressure
• High cholesterol levels
• Atherosclerosis
• Family history of heart or vascular disease

• Cramping pain in the calf region
• Fatigue or sensation of tiredness with or without pain in the buttock or thigh region
• Foot pain at rest, feet that are cold and or numb are all associated with severe, progressive disease
• Dry, scaly skin

Diagnosis of Intermittent Claudication
If Dr. King suspects that you have lower extremity arterial disease, he will ask you specific questions about the signs, symptoms, your lifestyle and medical history as well as physically examine you carefully. The diagnosis of lower extremity arterial disease is made through the examination of the overall appearance of the legs and feet, as well as the type of symptoms present, and whether or not pulses in the legs, feet and groin can be felt, or palpated by the doctor. Special tests may ordered after the exam and they fall into two basic categories, non-invasive and invasive.

Non-Invasive Testing
Non-Invasive testing is done in the vascular laboratory either at the Beachwood office or at the hospital. This is performed to check the blood flow to your lower extremities. Non-Invasive tests are painless and have no risks or side effects. They do not involve the use of needless, x-rays, or dye and no special preparation is required before the test and no observation afterwards. This allows the test to often be done the same day of the regular office visit, schedule permitting. They are done as an outpatient and all tests take less than one hour to perform. The results are given to Dr. King for evaluation and will be discussed with you, usually by telephone. There are several types of Non-Invasive tests that may be ordered, including arterial blood pressures, waveforms, and an exercise test.

• Doppler Ultrasound provides a sound analysis of the blood flow at different points along the leg. Blood pressure cuffs are placed around your arms and legs, and then the pressure readings are compared. You may be asked to walk on a treadmill and the blood pressures will be repeated. From these tests, the location and severity of your disease can be determined.
  
• Duplex Scanning tests provide an image of an artery or vein on a screen. This is very useful for locating blockages in an artery, for measuring the size of an artery and its blood flow. This can also be used to measure the size of a vein or it's narrowing, which may be necessary to use for a bypass of a diseased artery. For this test, you will need to lie very still after a cold, wet gel is applied to your leg and the technician will move the probe over the artery or vein being studied.
  
• Segmental Pressures Using blood pressure cuffs, pressures are taken at the ankle, calf and thigh and the measurements are compared to one another. This usually gives a clear, simple picture of the level of an arterial occlusion. Sometimes this is performed before and after walking on a treadmill. If the patient has severe atherosclerosis or if a significant amount of collateral circulation has developed, the segmental pressures may not reveal accurate arterial disease.
  
• Ankle to Arm Index Using a hand held Doppler, this test is a comparison of the arterial blood pressures in the arms compared to the blood pressures in the legs. It is sometimes done alone, or in combination before and after exercise.

Invasive Testing
Depending on the test results and or the symptoms, an invasive test, known as an arteriogram may be ordered to evaluate the location of any narrowing, blockage, or defect in the arteries of your lower extremities. This is performed in the x-ray department of the hospital either as an outpatient or during hospitalization. An arteriogram is obtained by the puncture of an artery and injecting dye through a small needle or catheter inserted into the blood vessel. Since it involves the injection of dye, you will be asked to sign a consent form. You will remain awake, although you may be given a medication to help you relax. You can expect the dye injection to cause a brief, hot burning sensation. Once the pictures are taken, you will be required to stay in bed and lie quietly for several hours. Once Dr. King has seen the results from the arteriogram, he will discuss the recommendations for further treatment with you.

Treatment and Surgery for Intermittent Claudication
Depending on the results of the testing and the severity and duration of the symptoms you are experiencing, a specific treatment recommendation will be suggested and discussed with you. For mild, stable disease non-surgical management of the intermittent claudication can often be achieved with lifestyle changes that may prevent the disease from worsening. Regular monitoring to reassess the situation will be recommended. If the claudication is disabling or steadily progressive, several treatment options are available.