Peripheral Arterial Disease and Claudication

Peripheral arterial disease (PAD) is a problem with blood flow in the arteries. Arteries carry blood from the heart to the muscles and organs in your body. When you have diseased arteries, they become narrow or blocked. The most common cause of narrow or blocked arteries is the buildup of fatty deposits. This is called atherosclerosis. The most common complaint of people who have PAD is claudication.

Claudication is pain in the calf or thigh muscle that occurs after you have walked a certain distance, such as a block or two. The pain stops after you rest for a while. Each time the pain occurs, it takes about the same amount of time for the pain to go away after you stop walking.

Claudication occurs because not enough blood is flowing to a muscle. PAD can cause the artery that normally supplies blood to the muscle to get narrow so that less blood can flow through the artery. When you're resting, enough blood flows to the muscle to meet the needs of the muscle. However, when you walk, the working muscle needs more blood. The narrowed artery may not let enough through.

Risk factors for claudication and PAD include high blood pressure, diabetes, high cholesterol, cigarette smoking and older age. Claudication is also more likely in people who already have atherosclerosis in other arteries, such as the arteries in the heart or brain. People with claudication may have had heart attacks or strokes.

If you notice pain in your legs while walking, ask your doctor about claudication and PAD.

Your doctor may suspect that your arteries have narrowed by listening to the blood flow in them, using a stethoscope. Then he or she may do some tests to see if you have PAD. Your doctor may also do tests to see if arteries in other parts of your body have atherosclerosis.

To check for claudication your doctor will check the pulses in the arteries in your legs. He or she may use a stethoscope to listen to the sound of your blood going through your arteries. Your doctor may hear a noise, called a bruit (say "brew-ee"), which may be a warning to your doctor that there is a narrow area in the artery.

Your doctor may order a test to check the blood flow in your leg. This test is often performed in a hospital lab.

The test for checking the blood flow in your legs is called a Doppler study. With this test, cuffs, like the ones used to measure blood pressure in your arm, are wrapped around your arm and your leg on the same side of your body. Four cuffs are wrapped around your leg--one at the upper thigh, one at the lower thigh, one at the upper calf and one at the ankle--to measure the blood pressure from the top of your leg to your ankle. A cuff is also wrapped around your upper arm to measure the blood pressure in your arm. The blood pressure in your arm is compared with the blood pressure in your leg. A drop in the blood pressure in your leg may indicate narrowing of an artery.

If surgery might help treat the symptoms of claudication, your doctor may recommend an arteriography. This is an x-ray taken after dye is injected into an artery. The dye study may show narrowing in an artery and provides a "map" for the surgeon who will do the surgery.

Yes. PAD and claudication are often treated with diet and exercise, and sometimes medicine. People with PAD or claudication should not smoke. It is important for these people to bring down high cholesterol, high blood pressure and high blood sugar levels.

A walking program is very helpful. You should walk at least 3 times a week for 30 to 45 minutes each time. Walk until the pain is too uncomfortable to continue. Stop and rest until the pain goes away. Then start walking again. If you begin an exercise program, such as walking or stair climbing, begin exercising slowly and gradually increase the time you spend exercising. You may see improvement in your symptoms within 2 months.

Medicine can help some people with PAD and claudication. Pentoxifylline (brand name: Trental or Pentoxil) or cilostazol (brand name: Pletal) may help your claudication. Ask your doctor if medicine is right for you.

If your arteries are badly blocked, you may need angioplasty (say "an-gee-oh-plas-tee") to open them up. In angioplasty, a thin tube called a catheter is inserted into the artery. A small balloon on the tip of the catheter is inflated. This helps to open up the artery. The balloon is then deflated and removed. Sometimes a device called a stent (a small wire mesh tube) will be left in the artery. The stent will help hold the artery open. Angioplasty is done while you are awake.

If the narrow area of the artery is very long, you may need to have surgery. For the surgery, your doctor will take a vein from another part of your body. The vein will be attached above and below the narrowed artery. This lets the blood flow around the narrowed area.