Peripheral Arterial Disease and Claudication

What is peripheral arterial disease?

Peripheral arterial disease (PAD) is a problem with blood flow in the arteries, especially those in the legs. Arteries carry blood from the heart to the muscles and organs throughout 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 inside them. This is called atherosclerosis. In PAD, your arms, and more commonly your legs don’t get enough blood flow. The most common complaint of people who have PAD is claudication.

What is claudication?

Claudication is pain in the calf, thigh or hip 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.

How are PAD and claudication related?

Claudication occurs because not enough blood is flowing to a muscle you are actively using. PAD can cause the artery that normally supplies blood to the muscle to grow 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 blood through.

Who is at risk of getting PAD or claudication?

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 already had heart attacks or strokes.

People with leg pain might think it’s from aging, arthritis or a diabetes-related symptom. PAD can be dangerous if it’s not treated. If you notice pain in your legs while walking, ask your doctor about claudication and PAD.

How can my doctor be sure I have PAD or claudication?

Your doctor may suspect that your arteries have narrowed and will check the pulses in arteries in your legs and feet. Your doctor will listen to the blood flow with a stethoscope or a small Doppler device. Your doctor may hear a noise, called a bruit (say "brew-ee"), which can be a warning that there is a narrowed area in the artery. Blood pressure in your ankles can also be compared to blood pressure in your arms. This test is called an ankle-brachial index, or ABI. Your doctor may do some other tests to look into possible PAD. He or she may also do tests to see if arteries in other parts of your body have atherosclerosis.

What other tests might be done?

Your doctor may order a test to check the blood flow in your leg. This test is often performed in a hospital lab, although some doctors can do a limited version of this test in their office.

A common test for checking the blood flow in your legs is called a PVR (pulse volume recording) 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. The cuffs are inflated slightly while you are lying down. As blood pulses through the arteries, the blood vessels expand, causing changes in the amount of air within the cuff. A recording device shows these changes.

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 doctor who will do the surgery.

Can PAD and claudication be treated?

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 to bring down high cholesterol, high blood pressure and high blood sugar levels.

A walking program is very helpful. You should walk at least 4 times a week for 30 to 60 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 start a new exercise program, such as walking or stair climbing, begin by exercising slowly and gradually increase the time you spend exercising. You may see improvement in your symptoms within 2 months.

If your arteries are badly blocked, you may need angioplasty 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 normally done while you are awake.

If the narrow area of the artery is very long, you may need to have bypass 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 part of the artery. This lets the blood flow around the narrowed area. Sometimes a synthetic (man-made) graft is used instead of a vein.

“Attitude is a little thing that makes a big difference.” Winston Churchill