Download Intermittent claudication

Intermittent claudication
Information for patients from the Vascular Surgery Service
This leaflet tells you about a condition known as intermittent claudication; it explains what the
condition is and describes the different treatment options. There are separate more detailed
leaflets about the radiological procedures and surgical operations available. This leaflet is not
meant to replace the information discussed between you and your doctor but can act as the
starting point for such a discussion or as a useful reminder of the key points.
What is intermittent claudication?
This is a cramp-like pain in the foot, calf, thigh or buttock brought on by exercise and which occurs
after walking a certain distance. It is usually caused by ‘hardening of the arteries’, a narrowing or
blockage to the main arteries in your legs due to fatty deposits lining the artery walls which builds
up over the years (atherosclerosis). People who smoke, are diabetic, have high blood pressure, or
have high cholesterol levels are more prone to this condition.
Pain is caused by reduced blood supply to the muscles due to the narrowing or blockages. The
circulation is sufficient when resting but the leg muscles cannot obtain enough blood supply for
exercise and pain occurs which is eased by resting. The pain comes on more rapidly with more
vigorous exercise, such as walking quickly or going up hill. If the condition becomes more severe,
it may lead to pain in the feet and toes at rest. Ulcers and gangrene may develop in a small
percentage of people. Patients with intermittent claudication rarely go on to these worse problems
but amputation can sometimes be a consequence of this condition.
Artery with fatty
material causing
narrowing
The blockage will never clear itself but the
symptoms can improve as smaller branches
open up to carry blood around a blockage. This
is called the collateral circulation.
Collateral vessal
Shows the developing
collateral circulation
diverting the blood
around the blocked artery
The natural history of claudication is that:
• 75% of patients will have little change in their condition. It may slightly improve with time plus
modification of lifestyle and exercise, or may worsen slowly
• 25% will have some deterioration and 5% will develop a severe problem where 2% of this
subgroup may eventually lose a leg
• in general it is better not to directly interfere with the arteries for treatment.
What can I do to help myself?
Modifications to your lifestyle will often prevent your symptoms from worsening. There are three
main aspects that need to be addressed.
1. Smoking – if you are a smoker you must stop as tobacco speeds up the blockage of your
arteries and also affects the development of the collateral circulation which is trying to
increase the blood circulation to your legs. Continued smoking also makes other treatments
less successful and makes amputation more likely. Help is available for you to quit.
2. Low fat diet – reducing the amount of fat in your diet will help to reduce your cholesterol
which in turn will help to reduce the amount of fat deposited in your arteries. You also require
drugs (statin) to lower cholesterol. Foods that are high in fat include dairy products, red
meats, biscuits, pastries, cake, and crisps. You should select more fish, chicken, turkey,
cereals, fruit, and vegetables. It is advisable to cook your food by grilling, steaming, or baking
which are preferable to frying and roasting food in oil. Products containing plant sterols can
also help to lower your cholesterol. If you are overweight, it is advisable to try to reduce your
weight because the more weight your legs have to carry, the more blood they will need and
the more pain you will suffer.
3. Regular exercise – there is good evidence that people develop a better collateral circulation
by taking regular exercise, walking at a steady pace until stopped by the pain, then
continuing again when the pain disappears. Try to walk a little further each day and you
should find that the distance you can manage without pain may slowly but steadily increase.
Exercise will only benefit your symptoms if continued over a period of time, preferably
forever, and if done regularly, preferably daily. This can be in a supervised program run in the
hospital.
How will my treatment be planned?
Your treatment will be planned depending on the severity of your symptoms and how it is affecting
your work or quality of life. In most cases, you will start with a conservative plan of treatment
lifestyle modifications, medications, and more exercise, and be encouraged to walk through the
pain to build up your collateral circulation. Stopping smoking is key.
Provided you have no history of stomach ulcers, you will be prescribed a low dose (75mg) of
aspirin and a statin which reduce the chances of more trouble with your circulation.
Are there alternatives?
If the symptoms worsen, do not improve, or are affecting your lifestyle greatly, a different line of
treatment may be undertaken. This involves an ultrasound scan or x-ray of the arteries using a dye
(angiogram) to highlight where the narrowings or blockages are. Narrowings and short blockages
can be stretched open with a balloon; this is called an angioplasty and may require an overnight
stay in hospital. Longer blockages may require surgery in the form of a bypass operation. This
is using a plastic tube or vein from your leg to bypass the blood flow around the blockage. If you
need surgery, the type of operation will be fully explained by your surgeon. All intervention to
arteries carries risks, these too will be discussed with you before you decide on how to proceed.
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Intermittent claudication, September 2016
Is the treatment safe?
As we said before, very few patients with intermittent claudication end up with an amputation. The
most important thing is that you improve your lifestyle and keep walking, change your diet, lose
weight, and stop smoking! The simple exercise program is very successful at increasing
walking distance. It provides a long term solution for the majority of people and most importantly it
is safe. Surgery and angioplasty are not always successful and can only be justified for a leg that
is threatened by very poor circulation (usually the pain is keeping you awake at night, or
ulceration or gangrene of the foot and toes has begun). Claudication is neither limb- nor lifethreatening, and it is not always safe or necessary to treat with angioplasty or surgery if the
symptoms are mild. Failed intervention can result in amputation.
Will I have to come back to hospital?
Your progress may be monitored as an outpatient by the vascular nurse specialists in their clinics.
The frequency of attendance will be determined by your individual condition and symptoms.
Alternatively, you may be referred to an exercise class to help the collateral vessels develop and
encourage a good lifestyle.
Finally…..
Many of your questions should have been answered by this leaflet but remember that this is only
a starting point for discussion about your treatment with the nurses and doctors looking after you.
Make sure that you are satisfied that you have received enough information about and treatment
and/or procedure before you sign the consent form for angioplasty or surgery.
Source of information
The information within this leaflet is based on current practice undertaken by your consultant and
from national guidelines. If you have any comments regarding this leaflet, we would appreciate
your feedback.
Where can I get more information?
If you have any questions or concerns, please contact one of the following: during the working day,
first try the vascular nurse or, if unable to get through or out of hours ask the hospital switchboard
for the vascular registrar on call.
• Vascular Nurse Practitioners
Telephone: 01227 864137
Email: [email protected]
• Kent and Canterbury Hospital (K&C) Telephone: 01227 766877
(out of hours for Registrar on call)
or your consultant’s secretary
• Mr Insall, Kent and Canterbury Hospital
Telephone: 01227 864259
• Mr Rix and Mr Senaratne, Kent and Canterbury Hospital Telephone: 01227 783196
• Mr Wilson, Kent and Canterbury Hospital
Telephone: 01227 864255
Useful web addresses
• National Institute for Health and Care Excellence www.nice.org.uk
• Vascular Society of Great Britain and Ireland www.vascularsociety.org.uk
• Circulation Foundation www.circulationfoundation.org.uk
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Intermittent claudication, September 2016
Any complaints, comments, concerns, or compliments
If you have other concerns please talk to your doctor or nurse. Alternatively please contact our
Patient Advice and Liaison Service (PALS) on 01227 783145 or 01227 864314,
or email [email protected]
Further patient information leaflets
In addition to this leaflet, East Kent Hospitals has a wide range of other patient information leaflets
covering conditions, services, and clinical procedures carried out by the Trust. For a full listing
please go to www.ekhuft.nhs.uk/patientinformation or contact a member of staff.
After reading this information, do you have any further questions or comments? If so,
please list below and bring to the attention of your nurse or consultant.
Would you like the information in this leaflet in another format or language?
We value equality of access to our information and services and
are therefore happy to provide the information in this leaflet in
Braille, large print, or audio - upon request.
If you would like a copy of this document in your language, please contact the ward or department
responsible for your care.
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отделение, ответственное за ваше лечение.
We have allocated parking spaces for disabled people, automatic doors, induction loops, and can
provide interpretation. For assistance, please contact a member of staff.
This leaflet has been produced with and for patients
Information produced by Vascular Team, East Kent Vascular Unit, Kent and Canterbury Hospital,
Canterbury
Date reviewed: September 2016
Next review date: January 2019
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