What's this ?
Intermittent claudication is the term that doctors attribute to pain, usually described as muscle cramp, which typically affects the calf, worsening with exercise and relieving with rest.
Causes
Most of the time, the intermittent claudiacation represents the typical manifestation of peripheral occlusive arterial disease. It is a morbid process that evolves slowly, leading to the formation of atheromas in the walls of the large arterial vessels [atheromas are lipid accumulations (cholesterol and fatty acids), cellular debris (especially macrophages), calcium salts and connective tissue]. This pathology, called atherosclerosis, takes the name of peripheral occlusive arterial disease when atheromas compromise the normal blood flow in the limbs, with serious repercussions on the functional capacity and quality of life of the patient. Although this lameness can be triggered by other causes, such as spinal canal stenosis, in this article we will deal with its link with occlusive peripheral arterial disease.
Symptoms
For further information: Symptoms Intermittent claudication
The typical manifestation of the intermittent claudication lies in the very meaning of the term, which we could Italianise into intermittent lameness. The patient complains of cramping pain during walking, localized in the calf when the femoro-popliteal artery is involved, or in the flank or buttock when the iliac artery is involved. Typically, the pain is relieved by rest, while when it persists for a long time even at the end of physical exercise, the vascular occlusion is particularly severe. The painful symptoms, as "it is easy to understand, depend on" insufficient blood flow under stress, whereby the muscle begins to work in anaerobiosis with the appearance of lactic acid and pain; if we want it is the same phenomenon that limits athletic performance in perfectly healthy subjects. Just as these sportsmen can elevate their performance through regular exercise, individuals who suffer from too intermittent claudication they can considerably improve their physical condition by carrying out the activity most suited to their state of health.
Occlusive peripheral arterial disease can be divided into four stages:
- I stage: absence of claudication;
- II stage: presence of intermittent claudication:
- IIa: distance traveled in the absence of pain less than at least 150 meters;
- IIb: distance covered in the absence of pain less than 150 meters;
- III stage: intermittent claudication with peripheral pain at rest;
- IV stage: intermittent claudication with peripheral tissue lesions (necrosis, gangrene).
Other symptoms that may accompany the intermittent claudication they are sexual impotence, diminution or absence of distal pulses, paleness, cyanosis and coldness of the extremities, reduced tolerance to physical exertion, peripheral paraesthesia (tingling), hair loss, thinning of the skin and the thickening of the nails.
Risk factors
- obesity,
- smoke,
- hypertension,
- prediabetes,
- diabetes,
- old age,
- hyperlipidemia,
- hyperfibrinogemia.
Diagnosis
Diagnosis is based on the search for the above symptoms and signs, with diagnostic confirmation by means of the index of systolic pressure at rest and during exercise (relationship between blood pressure measured at the ankle and in the arm), echo-color-doppler, angiography or MR angiography.
Useful to establish an adequate treatment, the plasma dosage of HDL, LDL, and total cholesterol, triglycerides, fibrinogen and glycaemia.
Treatment
See also: Medicines for the treatment of claudication intermittens
The treatment of Intermittent claudication depends on the severity of the lameness. Some general measures, such as the dietary-behavioral ones, are valid for all the clinical-developmental stages, while others are specific. Among the general interventions we remember the abolition of smoking, alcohol moderation and dietary correction. dyslipidemia, hyperglycemia, hypertension and overweight (see: diet and diabetes, diet and atherosclerosis, diet and hypertension). Physical activity is perhaps the best medicine, also by virtue of the few side effects; you should therefore avoid falling into that vicious circle whereby, due to the limp that accompanies it, the level of physical exercise is progressively reduced. Nothing could be more wrong; when walking causes particularly disabling problems, you can try cycling (perhaps that from a recumbent room), or vice versa; alternatively, water activities can be useful. All this, obviously, with the advice of an expert on the subject (physical activity, being like a real drug, can request a reduction in the dosage of medicines taken at the same time).
Pharmacological therapy can make use of antiplatelet, hypocholesterolemic, vasodilator, antihypertensive and hypotiglyceridemic agents. In the phytotherapeutic field, ginkgo biloba represents the drug par excellence in the treatment of intermittent claudication; garlic can also help. In both cases, the discourse made for physical activity is valid: the spontaneous use of these preparations must therefore be condemned and the preventive medical consultation encouraged.
In severe cases, the Intermittent claudication may require bypass surgery or angioplasty techniques.
