PAOD - Intermittent claudication

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 or Peripheral Arterial Occlusive Disease "PAOD" ) 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.

Smoking

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. Patients with arterial disease who continue to smoke are at increased risk of having a heart attack or stroke. Smoking cessation reduces the risk of these serious complications and, typically, doubles the distance those with intermittent claudication can walk.

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) or click the image below for more information (https://www2.hse.ie/quit-smoking/). Your doctor (GP) can also give you advice on nicotine gum, patches other medications or put you in touch with a support group.

 

Diet.

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.

Exercise.

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. The Circulation Foundation, a UK charity, provide information on how to help you improve your walking distance and reduce the risk of other arterial conditions [LINK].

TUH provide a dedicated exercise and risk modification programme that is suitable for some patients to assist in improving their walking distance and reducing cardiovascular risk. [LINK]  

Medications

Patients with proven PAOD may benefit from treatment with Aspirin (or a related medication) and  cholesterol reducing medication (even if your cholesterol is normal). You may also require medication if you have high blood pressure, diabetes or other conditions. In general, these medications are to reduce the risks of other cardiovascular complications and they do not usually help with walking distance.        

What about surgical treatments?

Most people with intermittent claudication do not require surgery and recent research suggest that patients do better with conservative treatment compared to angioplasty or surgery. However, if your symptoms are very severe, if they do not improve with conservative treatment, or if your surgeon is concerned that your limb is at risk, further treatment may be necessary. You can view the information page on angiogram/angioplasty on our website [LINK]

 

What is the risk of losing my leg?W

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.

ExWell programme

Some patients may be suitable for enrolment in the community based ExWell programme which helps those with certain medical conditions benefit from supervised exercise. Please discuss this with your Consultant or GP who will arrange to refer you, if appropropiate. This programme is available in the Tallaght and has worked well for many patients in our community. You can visit the ExWell website for further information (https://www.exwell.ie/).