Intermittent claudication - pain or a feeling of weakness and fatigue in the legs, occurring when walking. This symptom appears at the beginning of physical activity, and is at rest. Intermittent claudication - a symptom inherent in peripheral arterial disease of lower extremities, such as atherosclerosis.
The arteries of the heart is bleeding, enriched with oxygen and nutrients. Tissues receive oxygen and nutrients necessary for their activity and life, and give blood in exchange products - "slags." However, when the artery narrows, blood flow in the tissue breaks down. Tissues and cells are less necessary and oxygen. Such a condition called ischemia tissue. Usually manifested ischemia during physical activity when tissues need more volume of oxygen, whereas ischemia alone may not be apparent.
When physical activity such as walking, running, to the tissues by narrowed arteries is delivered to a smaller volume of blood, and therefore less oxygen and nutrients. This leads to the fact that accumulate in the tissues of metabolic products, including lactic acid. It is the accumulation of this acid and causes pain. This mechanism is also valid for coronary heart disease.
Intermittent claudication is one of the earliest signs of peripheral arterial disease. Narrowing of the arteries occurs not only in atherosclerosis. With this disease, as occlusive disease, and a narrowing of the arteries, however, in contrast to the narrowing in atherosclerosis is uniform, since the endarteritis not form plaques. This disease has a slightly different mechanism of development. However, it had a lower limb ischemia of tissues during walking and the manifestation of symptoms such as intermittent claudication.
Manifestations of intermittent claudication
Intermittent claudication manifests the appearance of pain, fatigue and discomfort in the legs when walking. Sometimes this may not be pain, but there are spasms in the calf muscles, weakness of the legs. The degree of manifestation of intermittent claudication depend on the degree of impaired circulation in the tissues. In the initial stages of this symptom can be manifested in walking distance to over a kilometer. The greater disturbance of blood flow in the legs, depending on the length of the quantities a, narrowing of the arteries, the greater the manifestation of ischemic legs. In the later stages of intermittent claudication is evident even after the patient was 100 meters. Intermittent claudication may be unilateral (characteristic of atherosclerosis) and bilateral (typical endarteritis).
Causes of intermittent claudication
As mentioned above, intermittent claudication - a sign of peripheral arterial disease of lower extremities, such as atherosclerosis and occlusive disease. The main mechanism of manifestation of pain in this condition - accumulation of lactic acid in the tissues. Risk factors for intermittent claudication
Risk factors for claudication are risk factors for atherosclerosis and other diseases of arteries of lower extremities:
High cholesterol in the blood
High blood pressure
Methods of diagnosis of intermittent claudication
Diagnosis, as with all other diseases, begins by asking the patient, collection and evaluation of his complaints. Next, the doctor finds the beginning and course of the disease. After that the inspection. Particular attention is paid to examination of the lower extremities. The doctor may also perform certain tests to ascertain the state of blood supply to your feet. However, the main diagnostic methods for peripheral vascular disease, including the arteries, are:
Determination of the shoulder ankle index - determined blood pressure on the shoulder and ankle. Normally, these figures should be the same. In diseases of the peripheral arterial pressure in the ankle is lower than in the shoulder area.
Biochemical analysis of blood for determination of cholesterol and lipids.
Duplex scanning - ultrasound method, which combines conventional ultrasound and Doppler.
Magnetic resonance angiography - a method that uses the energy of electromagnetic waves in a strong magnetic field, which allows to see the structure of tissues, including blood vessels.
Spiral computed tomography - a method of obtaining images of fibered tissues using X-rays followed by treatment with it on your computer.
Angiography - This method also allows you to see the structure of the vessels and their narrowing. To do this, through the femoral artery catheter, which is fed into the abdominal aorta, above the place of origin of the renal arteries. After that, through the catheter and contrast material is a series of x-rays.
Usually begins with a noninvasive research techniques such as ultrasound, tomography, magnetic resonance angiography. For more serious cases of vessels used invasive techniques such as angiography.
Treatment of intermittent claudication
Treatment of intermittent claudication is to treat the root cause of peripheral artery disease. Treatment includes lifestyle changes, diet, smoking cessation, exercise and weight loss, as well as taking certain medications, if necessary, and methods of endovascular surgery.
Exercise for treating intermittent claudication
Exercise - this is the initial phase of treatment of intermittent claudication. Your doctor will develop a special curriculum approach that is appropriate to your situation specifically. He will explain the type of exercise recommended by the intensity, duration, and frequency performance in a week. As an exercise recommended by the usual walking for 1 hour or more 3 or more times a week for at least 3-6 months, preferably under medical supervision. The purpose of this treatment - increase walking without the development of intermittent claudication.
Need to go until until intermittent claudication, usually within 3-5 minutes. Further, should continue to walk until you can tolerate more pain, usually 8-10 minutes. After this you should stop and rest until the pain is not fully take place, and then continue walking. Should be repeated periods of walking and recreation, gradually increasing the period of walking without pain from 30 minutes to 50. Thus, you would like to train the existing tissue blood flow, and in addition, in the muscles of the lower limbs, new blood vessels - so-called collaterals, which blood flows.
Drug treatment of intermittent claudication
At present, for the treatment of lower extremity arteries, the following drugs:
Lowering drugs cholesterol - statins
Vasodilators - nicotinic acid, but no-spa, etc.
Vazaprostan - now the main agent in the treatment of vascular disease, a beneficial influence on the vascular wall
Anticoagulants and Antiplatelet agents - drugs that reduce blood clotting and its viscosity, thereby reducing the risk of blood clots and increase the "flow" of blood in small blood vessels - capillaries. These include aspirin, klopidrogel, warfarin and other
If you have diabetes - antidiabetic drugs, including insulin
Diet for the treatment of intermittent claudication
Diet is also one of the highlights of a comprehensive treatment of diseases of the arteries. The diet should be restricted to the content of the diet of cholesterol and saturated fatty acids. We recommend eating vegetable fats - oils. They contain so-called polyunsaturated acids. It also recommended the use of fish: salmon, salmon, mackerel, sardines. These meats contain a substance like omega-3 fatty acids. These acids help to reduce triglycerides in the blood. Soybeans and many meat substitutes based on soy also reduced blood levels of low density lipoprotein.
The methods of endovascular surgery include:
angioplasty - a method which consists in expanding the lumen of the artery balloon catheter special, which is inserted into the femoral artery.
Stenting - angioplasty addition, this method consists in introducing into the lumen of the artery expanded stent - a special wire design that serves to frame it. bypass - a method which consists in the creation of a shunt to bypass the narrowed portion of the artery. As the graft is commonly used patient Vienna or artificial tube. Surgical treatment of intermittent claudication
The methods of surgical reconstruction of the arteries are endarterectomy and prosthetic arteries.