Claudication

Claudication causes aching, painful buttocks, thighs, and calves that start after you walk a distance or exercise. It gets better when you stop. If the blockage is bad, you might have constant pain at your toes (rest pain) or sores on your fingers and toes. If you don’t get treatment for claudication, it can lead to limb loss. At Mount Sinai, our vascular and endovascular surgeons are expert at diagnosing and treating this condition and can help you maintain an active lifestyle without pain.

About Claudication

Claudication is considered a disease, but it is really a symptom of other conditions. It is most often caused by peripheral artery disease (PAD), in which the arteries in the legs become narrow (called atherosclerosis), making it difficult for blood to flow. Other conditions that can cause claudication include:

• Peripheral neuropathy affects the nerves leading to your feet and hands.
• Deep vein thrombosis (DVT) happens when you have blood clots in your legs.
• Cystic adventitial disease (CAD) is when a fluid sac (cyst) forms in your artery wall, narrowing the blood vessel (stenosis). The cause is unknown, though it often involves the popliteal artery at the knee.  
• Endofibrosis of the iliac artery affects high-functioning athletes, causing scar tissue and narrowing of the artery (stenosis) that leads to numbness, swelling, and claudication.
• Popliteal artery entrapment syndrome (PAES) stems from an anomaly in the popliteal artery behind the knee that blocks blood flow. PAES can cause scarring, which can lead to narrowing of the artery (stenosis) or blockage (occlusion) if not identified early.

 You are more likely to experience claudication if you have these risk factors:

• African American ancestry
• Age (over 70)
• Diabetes
• Family history of atherosclerosis or claudication
• High blood pressure (hypertension)
• High cholesterol
• Obesity
• Sedentary lifestyle
• Smoking (especially over age 50)

Diagnosis and Treatment

We diagnose claudication through a thorough medical history, physical examination, and imaging tests including:

• Ankle-brachial index (ABI) compares the arm and leg circulation to tell us if you have PAD.
• Ultrasound (non-invasive sonogram) can help us determine the location and severity of the narrowed blood vessel.
• Computed tomography (CT) helps us map the blood flow in the affected area.
• Magnetic resonance imaging (MRI) enables us to see where the problem is and how narrow the artery is.
• Catheter-based angiography involves placement of a catheter in the groin arteries so that we can see the inside of the artery.

If our experts determine that you do have claudication, we will work with you to develop a treatment plan based on your overall health, history of vascular and other medical problems, and the location and severity of the blockage in your leg. We often use lifestyle changes, medicine, minimally invasive procedures, and/or open surgery, depending on the situation.

We may recommend you make lifestyle changes, such as:

• Increase exercise so that, for example,  you are walking at least a half hour a day
• Stop smoking
• Lose weight

We may also use medication to treat the condition or its symptoms. Medications can serve two purposes:

• Preventing heart attack and stroke (e.g., aspirin)
• Improving your ability to exercise (e.g., cilostazol)

If we need to perform a surgical procedure, we try whenever possible to use a minimally invasive approach (endovascular). The most common endovascular approaches to claudication are:

• Angioplasty involves inserting a tiny balloon through a narrow tube (catheter), then expanding it to open the artery and increase blood flow.
• Stenting entails inserting a metal mesh tube, also through a catheter, to keep the artery open and increase blood flow.

If you have extensive blockage, or if endovascular procedures haven’t helped, we may need to perform a traditional (open) procedure called bypass surgery to create an alternative route for blood flow. Under general anesthesia, we sew in a graft using either one of your healthy blood vessels or a synthetic tube to replace the clogged artery.