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Claudication

Claudication is the development of pain or cramping after physical exertion (like walking) secondary to decreased blood flow to a particular muscle group.

Typically, the legs, or lower extremities, are most commonly affected and the discomfort typically resolves with rest.

Peripheral artery disease (PAD) is usually the underlying cause. In these patients, atherosclerotic plaque deposition in the arterial vessel wall leads to areas of narrowing and even occlusion with resultant decreased flow. Talk to your doctor if you have any pain after exercising.

In some cases, conservative, or non-surgical, therapy can result in improved symptoms.

These include:

  • Rest
  • Quit smoking
  • Glucose control in diabetics
  • Blood pressure control
  • Cholesterol lowering medication
  • Antiplatelet therapy with a daily aspirin
  • A supervised exercise regimen
  • Cilostazol (a medication with demonstrated improvement in patients with intermittent claudication)

This commonly occurs in the aortoiliac region, where the largest artery in the body, the aorta, branches into 2 vessels. The right and left common iliac arteries serve as the main trunks from the aorta providing blood flow to the pelvis and lower extremities. When patients continue to have symptoms like pain with walking and the non-surgical measures have been tried, an intervention may be required in order to increase blood flow and improve symptoms. There has a move toward more minimally invasive procedures like angioplasty and stent placement, when appropriate, in patients who need additional treatment.

A CLEVER Clinical Trial

Given the lack of clear evidence of whether intervention with angioplasty and stent placement was significantly better than conservative measures in this patient population, the Claudication: Exercise Vs. Endoluminal Revascularization (CLEVER) trial was conducted. In this prospective, randomized study patients with claudication and aortoiliac disease were assigned to three treatment groups:

  • Optimal medical care (OMC) alone
  • Supervised exercise (SE) plus OMC
  • Stent revascularization (ST) plus OMC

The key results of this study included significant improvement in pain free distance walked (peak walking time) in the SE and ST group when compared to OMC alone. At the end of six months, the SE group walked the farthest pain free, however the ST group was found to have the most improved quality of life.

In summary, a supervised exercise program is better than lifestyle modification alone but patients feel better after intervention with angioplasty and stent placement.

Interventional radiologists are trained in the performance of minimally invasive procedures like angioplasty and stent placement. In addition, they are vascular specialists who evaluate and clinically manage patients with PAD. They work closely with other physicians across a spectrum of clinical specialties to ensure comprehensive care is provided to the patient.

If you are experiencing any symptoms, do not hesitate to request a referral to the vascular and interventional radiology service. You can be assured that there is a team of specialists available and waiting to provide the best care possible for your condition.

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