John P. Cunha, DO, FACOEP
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- What is claudication?
- What are the causes of claudication?
- What are the symptoms of claudication?
- Why does claudication come and go?
- What can cause the artery narrowing that leads to claudication?
- Who typically is affected by claudication?
- What are the risk factors for claudication and peripheral vascular disease?
- How is claudication diagnosed?
- How is claudication treated?
- Can claudication be prevented?
- What is the prognosis and treatment for patients with intermittent claudication?
- Find a local Cardiologist in your town
How is claudication diagnosed?
A physician will take a history and the diagnosis will be based on the patient's symptoms.
Testing for claudication may include:
- Ultrasound is most commonly used to determine location and severity of the narrowing in the blood vessels.
- Ankle-arm index measures the blood pressure at the ankle compared with the blood pressure in the arm. An abnormal result is an indication of peripheral artery disease.
- Segmental blood pressure measures blood pressure in different parts of the leg (calf, low thigh, high thigh) to detect a blockage that is causing decreased blood flow.
- Computed tomography (CT) and magnetic resonance angiography (MRA) are other noninvasive tests that can help a doctor map the blood flow in the affected areas. These tests may be considered if the patient's doctor thinks that a procedure (revascularization) to treat peripheral artery disease may be helpful.
What is the treatment for claudication?
There are two main ways to treat claudication: medication and a surgical treatment, called revascularization.
Medication therapies are often used initially as they are non-invasive. The two most commonly used medications include:
- Cilostazol (Pletal) reduces the pain of intermittent claudication by widening (dilating) the arteries, thereby improving the flow of blood and oxygen to the legs.
- Pentoxifylline (Trental) decreases the "stickiness" (viscosity) of blood and thereby improves its flow through arteries. This increases the flow of blood and oxygen to muscles.
There are several drugs being investigated to treat claudication. These medications are not yet approved for use in treating this condition. These medications include:
- ACE (angiotensin converting enzyme) inhibitors
- Antichlamydophila therapy –- roxithromycin
A surgical procedure called a revascularization is used in patients who do not respond to medications. There are two types of revascularization procedures: endovascular (inside the blood vessel) and surgically grafting or bypassing the artery.
- Endovascular procedures include:
- Angioplasty: A balloon is placed in the blocked area and inflated to widen the diameter of the artery and increase blood flow
- Stenting: Wire mesh used to hold a blood vessel open after angioplasty and prevents scar tissue from narrowing the blood vessel
- Surgical grafting or bypassing an artery involves an open surgery with an incision and sewing in a graft using either the patient's vein or a synthetic tube to increase blood flow around the blocked area.
- Compression therapy can also be used as a noninvasive way to treat symptoms of claudication. Intermittent calf compression has been shown in studies to improve symptoms-free walking distance.
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