1. What is Intermittent Claudication?
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| Claudication is the name given to pain in the leg
caused by "furred up" or blocked arteries. If you have
claudication, you can walk a little and then you get pain in
either the calf, thigh or buttock. For some people the pain can
be in all of these areas. The pain is usually like bad cramp and
most people have to stop walking. After a few minutes the pain
goes away and you can usually walk for the same distance or
amount of time before the pain comes on again. |
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2. What causes the pain?
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| When we walk, our leg muscles need oxygen and
other nutrients to work. If you have claudication, the main
arteries to the leg (like motorways) are narrowed (only one lane
rather than 3) or blocked (motorway closed). Like cars the blood
can pass through the narrowed areas if the muscles do not need
much oxygen. If the artery is blocked then like cars, the blood
passes along other arteries called collateral vessels (Like A
and B roads). If the muscles need more oxygen when you walk, the
blood cannot get through fast enough (like holiday traffic) so
the muscle has to work a different way (anaerobic respiration).
The by-product of anaerobic respiration is lactic acid. It is
this acid that causes the muscle pain or cramps. When you stop
walking, the blood "catches up" and washes out the
acid so the pain goes away. When you walk again, the whole
process repeats itself. |
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3. Does the blockage ever clear itself?
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| No, unfortunately not, but the situation can
improve due to opening up of the smaller collateral arteries
which carry blood around the block. It is a bit like the body
turns A roads into dual carriage ways. Many people notice some
improvement, as the collateral circulation opens up, within
six to eight weeks of the onset of claudication. |
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4. What happens if I am referred to Mr Braithwaite?
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| Mr Braithwaite will usually see patients with
claudication at a special "one-stop" clinic at Queen's
Medical Centre, Nottingham. If not people will often be asked to
attend the vascular laboratory for assessment.
When Mr Braithwaite sees you, he will ask some questions and
then examine your legs. He may measure the blood pressure in
your legs using a special ultrasound machine called a Doppler
probe. You will then be asked to walk on a treadmill similar to
those seen in gymnasiums. Depending on the result of this test,
Mr Braithwaite may advise you to change some of your lifestyle.
He may arrange a duplex ultrasound test to see where the
blockage is in your arteries. In some cases he may arrange a
magnetic resonance scan of you arteries. If so, you may have to
wait for an appointment from the x-ray department at QMC. It is
possible that Mr Braithwaite will discuss the need for an angioplasty.
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5. How can I help myself?
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There are several things you can do which may
help. The most important is to stop smoking, take regular
exercise and lose weight.
Smoking. If you are a smoker you
must make a sincere and determined effort to give up completely. Tobacco
is harmful on two counts. Firstly, it speeds up the hardening of
the arteries, which is the basic cause of the trouble and
secondly, cigarette smoke clamps down the small collateral
vessels and reduces the amount of blood and oxygen to the
muscles. The best way to give up is to choose a day when
you are going to stop completely rather than trying to cut down
gradually. If you do have trouble giving up please ask your
doctor who can give you advice on nicotine gum and patches or put
you in touch with a support group.
Diet. It is very important not to
put on weight, because the more weight the legs have to carry around
the more blood they will need. Your doctor or dietician will
give you advice with regard to a weight reducing diet. If
your blood cholesterol is high you will need a low fat diet and
may also require cholesterol lowering drugs.
Exercise. There is good evidence
that people who take regular exercise (walking at an easy pace until
pain comes, on then stopping and continuing again when the pain
disappears) develop a better collateral circulation. Try
and make it a little further each day, and you will almost
certainly find that the distance you can manage without
pain slowly but steadily increases. |
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6. What about treatment?
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Most people with intermittent claudication do not
require surgery but if your symptoms are very severe, or if
they do not improve, further treatment may be necessary. An
x-ray of the arteries (arteriogram)
is usually performed first to see what can be done. Short
blockages can be stretched open with a balloon
(angioplasty) in the x-ray department. This is usually done
under local anaesthetic and often involves an overnight
stay in hospital.
Longer blockages are bypassed using a plastic tube or vein from
the leg (bypass graft). This is a major operation under
general anaesthetic and involves being in hospital for about a
week to ten days.
The decision about surgery is usually one for you to make
yourself after your specialist has explained the likelihood of success and the risks involved. More
detailed information about these procedures is also
available - please ask Mr Braithwaite. |
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7. Do drugs help?
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| Although there are quite a number of proprietary
tablets and drugs on the market there is very little evidence
that they actually help - drugs will not unblock the artery.
Perhaps your doctor has already tried one of these drugs in
your case, so that you can judge for yourself. Aspirin is
commonly prescribed because it makes the blood less sticky.
A new drug called Plavix may help. |
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8. What is the risk of losing my leg?
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| Very few patients with intermittent claudication
end up with an amputation and Mr Braithwaite will make
every effort to avoid it. The most important thing is that you
improve your lifestyle - keep walking, lose weight, take
aspirin and stop
smoking! |
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