My leg muscles hurt when I walk….
I can’t manage hills without a short stop….
I often need to stop and hang on to a lamp post or pretend to be interested in shop windows….
If this sounds familiar then you may be one of the thousands of people suffering from intermittent claudication.
Intermittent claudication is pain in the leg that comes on when the muscles are working, caused by narrowing of the arteries supplying the muscles with blood. This “furring-up” of the arteries is all part of ageing, but in some people the process is greatly accelerated. We know that cigarette smoking, high blood pressure, raised cholesterol and diabetes can all play a part. One in five men over 50 is thought to have some degree of intermittent claudication but women can also be affected.
Your GP should be able to tell you if the pain in your leg is intermittent claudication. If you get pain in the muscle of your calf or thigh when you walk, pain that comes on sooner when you walk more quickly or walk up hill, but eases after a few minutes rest – then go and see your doctor. He or she will need to know exactly how far you can walk before the pain stops you, and will need to examine your legs and feel or listen for foot pulses.
If you do have blood flow problems what does it mean and what will happen next? First of all if you smoke you must stop immediately – nicotine and carbon dioxide inhaled from tobacco smoke damage blood vessels, reduce the amount of oxygen blood can carry and constrict small blood vessels. Your doctor may suggest you take an aspirin every day, aspirin helps by thinning the blood. A referral to a Vascular Surgeon or a Vascular Laboratory may also be suggested.
The Royal Sussex County Hospital in Brighton has one of the busiest Vascular Laboratories in the UK, the technicians at the laboratory can perform a range of tests to confirm intermittent claudication and pinpoint the arteries involved. These tests are painless and do not involve any needles or injections. Most patients seeing a Vascular Surgeon will be examined, have a blood test, be warned again to stop smoking and advised what they can do to help themselves. If the arterial narrowing is advanced then x-rays of the arteries may be needed. There are no pills that can make the problem go away but there are treatments that can help stop the condition progressing. If the arteries are blocked then bypass surgery may be the only option.
Intermittent claudication can be serious, left unchecked it can lead to amputation. Occasionally it can be acute and when a patient is suspected of having an acute occlusion the case must be discussed immediately with a Vascular Surgeon who will refer to the Vascular Laboratory for initial assessment. The speed of this assessment and the hours saved by the immediate availability of a Vascular Laboratory can make the difference between death, loss of leg or complete recovery of limb function to normal after treatment. The rehabilitation after amputation can take many months and only a few walk successfully with their artificial limbs.
By Simon Ward
Vascular Assessment Unit
Royal Sussex County Hospital