Intermittent Claudication

Wikis > Peripheral Vascular Disease > Intermittent Claudication

Common presenting complaint of occlusive PVD. Pain in group(s) of exercising muscle(s) – often described as a cramp, tightness, paralysis, sharp pain – sometimes just a dull ache or tiredness – rapidly relieved on rest.

ABI generally <0.7

Almost always occurs after having walked a certain distance (claudication distance) – becomes too painful to continue.

Generally, the site of vascular occlusion is one joint proximal to the location of the claudication pain.

Pain due to insufficient oxygen getting through to meet the tissues metabolic needs. The pain is usually distal to the occlusion and its severity is generally related to the degree of occlusion.

 

Key features- no pain at rest or initial steps; consistent walking distance; relief within 2-3 minutes of stepping; recurs on walking same distance; worse if walk fast or up slope

 

Differential diagnosis:

  • Atherosclerosis
  • Other vascular (thromboangiitis obliterans; Takayasu’s arteritis; Giant cell arteritis; arterial embolism; popliteal artery entrapment syndrome)
  • Musculoskeletal/biomechanical/soft tissue
  • Rheumatological
  • Referral of pain from lower back/nerve root compression/cauda equina syndrome (pseudoclaudication or neurogenic claudication)

Up to half of those reporting typical claudication pain were found to possibly have other causes [1]

A history of intermittent claudication has been shown to only have a sensitivity of 50% and specificity of 87% for the diagnosis of an ABI <0.5 in those with diabetes [2].

 

[1]Criqui MH, Fronek A, Klauber MR, Barrett-Conner E, Gabriel S: The sensitivity, specificity, and predictive value of traditional clinical evaluation of peripheral arterial disease: results from noninvasive testing in a defined population. Circulation 71:516-522 1985

 

[2]Boyko EJ, Ahroni JH, Davignon D, Stensel V, Prigeon RL, Smith DG: Diagnostic utility of the history and physical examination for peripheral vascular disease among patients with diabetes mellitus. Journal of Clinical Epidemiology 50:659-668 1997

 

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