What is Intermittent Claudication?
The pain you feel in your legs is called intermittent claudication. This occurs because the blood flow into your legs is reduced because of narrowing (hardening) of the arteries (atherosclerosis) supplying the legs. Over a period of time, cholesterol and calcium build up inside the arteries. This occurs much earlier in people who smoke and those who have diabetes or high levels of cholesterol in the blood.
The circulation is usually sufficient when you are at rest (doing nothing, sitting or standing). However, when walking, the calf muscles cannot obtain enough blood and cramp occurs. This is made better by resting for a few minutes. If greater demands are made on the muscles, such as walking uphill, the pain comes on more quickly.
Does the blockage ever clear itself?
No, unfortunately not, but the situation can improve due to opening up of smaller arteries (collateral circulation) which carry blood around the block. Many people notice some improvement, as the collateral circulation opens up, within six to eight weeks of the onset of claudication.
How can I help myself?
There are several things you can do which may help. The most important is to stop smoking, take regular exercise and lose weight.
If you are a smoker you must make a sincere and determined effort to give up completely. Tobacco is harmful on two counts. Firstly, it speeds up the hardening of the arteries, which is the basic cause of the trouble and secondly, cigarette smoke clamps down the small collateral vessels and reduces the amount of blood and oxygen to the muscles. The best way to give up is to choose a day when you are going to stop completely rather than trying to cut down gradually. If you do have trouble giving up, you should try contacting the National Smokers' Quitline (1850 201 203). Your doctor (GP) can also give you advice on nicotine gum, patches other medications or put you in touch with a support group.
You do need to avoid putting on weight and need to pay attention to what you eat - particularly as the ability to exercise is compromised by the leg pains. You should eat a diet that is rich in fruit and vegetables and fibre but low in fat (especially saturated fat). If your blood cholesterol is high, you may also require cholesterol lowering drugs.
There is good evidence that people who take regular exercise (walking at an easy pace until pain comes, on then stopping and continuing again when the pain disappears) develop a better collateral circulation. Walk for 20 minutes twice a day, stopping when you have to, and then walking on again. Try and make it a little further each day, and you will almost certainly find that the distance you can manage without pain slowly but steadily increases. It might also help to take exercise which doesn't involve walking such as swimming or cycling.
What about treatment?
Most people with intermittent claudication do not require surgery but if your symptoms are very severe, or if they do not improve, further treatment may be necessary. An x-ray of the arteries (arteriogram) is usually performed first to see what can be done.
Short blockages can be stretched open with a balloon (angioplasty) under XRay control. This is usually done under local anaesthetic and often involves at least an overnight stay in hospital.
Longer blockages are bypassed using a plastic tube or, more commonly vein from the leg (bypass graft). This is a major operation under general anaesthetic and involves being in hospital for about a week to ten days. Surgery carries certain risks including the possibility that the artery may block off again making your problem worse or, in a worst case scenario, putting you at risk of losing your leg (amputation). Surgery may also result in heart or breathing problems, blood clots, or bleeding.
The decision about surgery is usually one for you to make yourself after your surgeon has explained the likelihood of success and the risks involved.
Do drugs help?
Aspirin (or other similar drugs) help prevent further blockages which could make the problem worse or cause a heart attack or stroke. Cholesterol lowering medication may help slow or reverse the hardening of your arteries. Although there are quite a number of other drugs on the market there is very little evidence that they actually help you walk any further
What is the risk of losing my leg?
Very few patients with intermittent claudication end up with an amputation and we will make every effort to ensure this does not happen. The most important thing is that you improve your lifestyle - stop smoking, keep walking, eat healthily and take your medications. But above all stop smoking.