Materiały źródłowe

• #1 Claudication – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/claudication/diagnosis-treatment/drc-20370959

  Claudication may go undiagnosed because many people consider the pain to be an unwelcome but typical part of aging. Some people simply reduce their activity level to avoid the pain. […] A diagnosis of claudication and peripheral artery disease is based on a review of symptoms, a physical exam, evaluation of the skin on the limbs, and tests to check blood flow. […] Some common tests used to diagnose claudication may include: […] Ankle-brachial index, a comparison of blood pressure in the ankles with the blood pressure in the arms […] Exercise testing to determine the maximum distance you can walk or the maximum exertion without pain. […] When peripheral artery disease is severe and other treatments don’t work, surgery may be required. Options include: […] Your health care provider may prescribe one or more medications to control pain and manage risk factors for cardiovascular disease.

• #2 Claudication: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21972-claudication

  Claudication is muscle pain that happens when you’re active and stops when you rest. […] Early diagnosis and treatment lead to better outcomes. […] Vascular claudication is usually a symptom of serious blood flow problems, especially peripheral artery disease (PAD). […] To find out if you have claudication or how severe your case is your healthcare provider will perform a physical exam. […] A provider may order these tests to diagnose claudication: Ankle-brachial index, Angiography, Ultrasound. […] Treating claudication is important because it usually means you have peripheral artery disease or another circulatory disease that can be life-changing and even deadly. […] If medicines don’t work, your provider may want to do a minimally invasive treatment. […] Claudication won’t go away by itself. You’ll need some level of treatment to manage it. […] Early diagnosis and treatment can prevent or delay the worsening of claudication symptoms to the point where they impact your life.

• #3 Intermittent claudication

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1635612/

  Patients with intermittent claudication have a significantly higher mortality than age matched controls, about 12% a year. […] The natural course of intermittent claudication is benign for the leg affected, with few patients ever requiring intervention or amputation. Only one in four patients with intermittent claudication will develop any deterioration in symptoms. […] Recognise the symptoms of intermittent claudication early […] Ideally, confirm the diagnosis by measuring ankle-brachial pressure indices in the community […] There is clear evidence that antiplatelet drugs reduce major cardiovascular events. They also reduce the risk of arterial occlusion and the requirement for revascularisation procedures. […] There is some evidence that statins improve the symptoms of claudication, increasing walking distance and pain-free walking time.

• #4 Intermittent claudication

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1635612/

  Intermittent claudication is a common condition and in most cases is easily diagnosed […] The diagnosis of intermittent claudication is based on a classic history of cramping muscle pain that occurs after the same degree of exercise and which is quickly relieved by rest. […] Absent or reduced peripheral pulses or the presence of audible bruits supports the diagnosis of intermittent claudication, but some patients with the condition will have normally palpable pulses and no bruits. A low ankle-brachial pressure index (0.9) also supports the diagnosis. However, the presence of palpable pulses or a normal resting ankle-brachial pressure index (0.9) does not rule out the diagnosis. If the clinical history is highly suggestive of intermittent claudication and the ankle-brachial pressure index is normal, an exercise ankle-brachial pressure index should be performed. If a substantial drop in ankle pressure is observed after exercise and at the same time as symptoms develop, a diagnosis of intermittent claudication can confidently be made.

• #5 Intermittent Claudication – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430778/

  Intermittent claudication (IC) typically refers to lower extremity skeletal muscle pain that occurs during exercise. IC presents when there is insufficient oxygen delivery to meet the metabolic requirements of the skeletal muscles. IC is a common manifestation of peripheral arterial disease (PAD), which includes atherosclerotic stenosis of arteries in the extremities. IC is commonly localized to the thigh, hip, buttock, and calf muscles. Pain within these muscle groups is reproducibly induced by walking and relieved with rest. […] The key feature of intermittent claudication is that the muscle discomfort is reproducible. The pain usually comes on during physical activity and subsides after a period of rest. The key reason for the pain is inadequate blood flow. Intermittent claudication is a very common problem seen in patients with diabetes mellitus and people who smoke.

• #6 Diagnosis And Treatment Options For Claudication – Klarity Health Library

  https://my.klarity.health/diagnosis-and-treatment-options-for-claudication/

  Claudication is cramping or pain which can occur in the legs during exercise and is caused by a blockage or narrowing in the arteries. […] Early detection and treatment of claudication is essential, as the condition can worsen over time, and further problems can develop. […] Diagnosis begins with the clinician taking a medical history from the patient, to find out about the smoking history, the presence of diabetes, and identifying other past problems such as heart attack, and stroke. […] Diagnostic tests can also be used, an example of which is the ankle-brachial pressure index. […] Treadmill exercise testing is also useful, as the ABPI can be taken at rest, and then repeated after exercise. […] Duplex ultrasound can help to pinpoint the exact location of blockages or narrowings in the arteries.

• #7 Claudication | Vascular Center | UC Davis Health

  https://health.ucdavis.edu/vascular/diseases/claudication.html

  Claudication refers to the pain, aching or fatigue of the muscles of the buttocks, thigh and/or calf that occurs with exertion. […] Your doctor may identify and locate the cause of claudication using one or more of the following methods: […] Auscultation: The presence of a bruit, or whooshing sound, in the arteries of the legs is confirmed using a stethoscope. […] Ankle-brachial index (ABI): The systolic blood pressure in the ankle is divided by the systolic pressure at the arm. […] Doppler ultrasound: This form of ultrasound can measure the direction and velocity of blood flow through the vessels. […] CT angiography: An advanced X-ray procedure that uses a computer to generate three-dimensional images of blood vessels. […] Magnetic resonance angiography (MR angiography): The patient is exposed to radiofrequency waves in a strong magnetic field. The energy that is released is measured by a computer and used to construct two- and three-dimensional images of the blood vessels. […] Angiogram: An X-ray study of the blood vessels using contrast dyes.

• #8 Intermittent claudication

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1635612/

  Intermittent claudication is a common condition and in most cases is easily diagnosed […] The diagnosis of intermittent claudication is based on a classic history of cramping muscle pain that occurs after the same degree of exercise and which is quickly relieved by rest. […] Absent or reduced peripheral pulses or the presence of audible bruits supports the diagnosis of intermittent claudication, but some patients with the condition will have normally palpable pulses and no bruits. A low ankle-brachial pressure index (0.9) also supports the diagnosis. However, the presence of palpable pulses or a normal resting ankle-brachial pressure index (0.9) does not rule out the diagnosis. If the clinical history is highly suggestive of intermittent claudication and the ankle-brachial pressure index is normal, an exercise ankle-brachial pressure index should be performed. If a substantial drop in ankle pressure is observed after exercise and at the same time as symptoms develop, a diagnosis of intermittent claudication can confidently be made.

• #9 Lower Extremity Peripheral Artery Disease: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0315/p362.html

  Intermittent claudication is the hallmark of atherosclerotic lower extremity PAD, but only about 10% of patients with PAD experience intermittent claudication. […] Current guidelines recommend resting ankle-brachial index (ABI) testing for patients with history or examination findings suggesting PAD. […] Patients with symptoms of PAD but a normal resting ABI can be further evaluated with exercise ABI testing. […] The 2016 American Heart Association/American College of Cardiology (AHA/ACC) guideline on the management of patients with lower extremity PAD recommends patients at increased risk of PAD should be assessed for exertional leg symptoms, ischemic rest pain, and nonhealing wounds. […] The ABI is the ratio of the highest systolic pressure in each leg, obtained at the dorsalis pedis and posterior tibial recurrent arteries using a Doppler probe, to the higher of the right or left arm brachial artery pressures.

• #10 Diagnosis and Treatment of Peripheral Arterial Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0901/p306.html

  Peripheral arterial disease (PAD) is atherosclerosis leading to narrowing of the major arteries distal to the aortic arch. The most common presenting symptom is claudication; however, only 10% of patients have classic claudication. The ankle-brachial index (ABI) can be used to screen for and diagnose PAD in the primary care setting. […] The clinical history and physical examination findings may suggest a diagnosis of PAD, especially in patients with multiple risk factors or classic claudication. Claudication must be distinguished from spinal stenosis (i.e., pseudoclaudication), peripheral neuropathies, musculoskeletal disorders and injuries, and deep venous thrombosis. […] The ankle-brachial index (ABI), the ratio of the ankle blood pressure to the highest brachial systolic pressure, is an inexpensive and efficient method to diagnose PAD in the primary care setting. It is highly sensitive (90%) and specific (98%). […] Diagnostic parameters for PAD at specific ABI values are listed in Table 2. […] Surgical revascularization should be considered in patients with lifestyle-limiting claudication symptoms that do not respond to exercise and pharmacologic treatment.

• #11 Peripheral Arterial Occlusive Disease: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/460178-overview

  Claudication, which is defined as reproducible ischemic muscle pain, is one of the most common manifestations of peripheral arterial occlusive disease (PAOD) caused by atherosclerosis. Claudication occurs during physical activity and is relieved after a short rest. Pain develops because of inadequate blood flow. […] Angiography is the criterion standard arterial imaging study for the diagnosis of PAOD. […] Examination of a patient with claudication should include a complete lower-extremity evaluation and pulse examination, including measuring segmental pressures. […] A useful tool in assessing a patient with claudication is the ankle-brachial index (ABI), which is a noninvasive way of establishing the presence of PAOD and is calculated as the ratio of systolic blood pressure at the ankle to that in the arm (normal range, 0.9-1.1; PAOD, 0.9).

• #12 Peripheral Arterial Occlusive Disease

  https://fpnotebook.com/Surgery/CV/PrphrlArtrlOclsvDs.htm

  Claudication derived from latin claudicatio, to limp […] Ankle-Brachial Index: ABI is the Vital Sign of Peripheral Arterial Disease […] Obtain for diagnosis and monitor periodically for disease progression […] Ankle-Brachial Ratio 0.3: Limb Threatening Ischemia (requires emergent intervention) […] Intermittent Claudication progresses to Critical Limb Ischemia in 21% of cases […] Critical Limb Ischemia is associated with a 25% annual mortality rate (esp. due to cardiovascular cause).

• #13 Intermittent claudication

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1635612/

  Intermittent claudication is a common condition and in most cases is easily diagnosed […] The diagnosis of intermittent claudication is based on a classic history of cramping muscle pain that occurs after the same degree of exercise and which is quickly relieved by rest. […] Absent or reduced peripheral pulses or the presence of audible bruits supports the diagnosis of intermittent claudication, but some patients with the condition will have normally palpable pulses and no bruits. A low ankle-brachial pressure index (0.9) also supports the diagnosis. However, the presence of palpable pulses or a normal resting ankle-brachial pressure index (0.9) does not rule out the diagnosis. If the clinical history is highly suggestive of intermittent claudication and the ankle-brachial pressure index is normal, an exercise ankle-brachial pressure index should be performed. If a substantial drop in ankle pressure is observed after exercise and at the same time as symptoms develop, a diagnosis of intermittent claudication can confidently be made.

• #14 Lower Extremity Peripheral Artery Disease: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0315/p362.html

  The 2016 AHA/ACC guideline recommends resting ABI testing for patients with history or examination findings suggestive of PAD. […] For patients at increased risk of PAD, but without suggestive history or examination findings, resting ABI testing is considered reasonable. […] If the physical examination and resting ABI or toe-brachial index do not definitively diagnose lower extremity PAD despite a history of exertional claudication, then exercise ABI testing may be performed. […] Patients with claudication in whom maximal risk factor treatment and supervised exercise therapy have failed and who are truly limited in daily activities should be referred to a vascular surgeon.

• #15 Intermittent claudication

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1635612/

  Intermittent claudication is a common condition and in most cases is easily diagnosed […] The diagnosis of intermittent claudication is based on a classic history of cramping muscle pain that occurs after the same degree of exercise and which is quickly relieved by rest. […] Absent or reduced peripheral pulses or the presence of audible bruits supports the diagnosis of intermittent claudication, but some patients with the condition will have normally palpable pulses and no bruits. A low ankle-brachial pressure index (0.9) also supports the diagnosis. However, the presence of palpable pulses or a normal resting ankle-brachial pressure index (0.9) does not rule out the diagnosis. If the clinical history is highly suggestive of intermittent claudication and the ankle-brachial pressure index is normal, an exercise ankle-brachial pressure index should be performed. If a substantial drop in ankle pressure is observed after exercise and at the same time as symptoms develop, a diagnosis of intermittent claudication can confidently be made.

• #16 Lower Extremity Peripheral Artery Disease: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0315/p362.html

  The 2016 AHA/ACC guideline recommends resting ABI testing for patients with history or examination findings suggestive of PAD. […] For patients at increased risk of PAD, but without suggestive history or examination findings, resting ABI testing is considered reasonable. […] If the physical examination and resting ABI or toe-brachial index do not definitively diagnose lower extremity PAD despite a history of exertional claudication, then exercise ABI testing may be performed. […] Patients with claudication in whom maximal risk factor treatment and supervised exercise therapy have failed and who are truly limited in daily activities should be referred to a vascular surgeon.

• #17 Peripheral arterial disease – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/peripheral-arterial-disease/

  Diagnosis of acute limb ischemia is discussed separately. […] In patients with clinical features of PAD, measure resting ABI. PAD is confirmed if ABI is 0.9. If ABI is 0.9: Confirm PAD with additional testing (e.g., exercise ABI, toe-brachial index) based on clinical presentation. […] Resting ABI is the first-line diagnostic test for suspected nonacute PAD (i.e., intermittent claudication, rest pain, or nonhealing ulcers or gangrene in the lower limbs). […] A low ABI ( 0.9) and a high ABI ( 1.4) are associated with an increased risk of all-cause and cardiovascular mortality. […] Exercise ABI testing is indicated in patients with a normal or borderline resting ABI to evaluate functional status. […] Toe-brachial index with waveforms is indicated for resting ABI 1.4 and suspected PAD. […] Imaging may be considered in symptomatic patients if the diagnosis of PAD is uncertain.

• #18 PAD (Peripheral Artery Disease) – – Diagnosis, Evaluation and Treatment

  https://www.radiologyinfo.org/en/info/pad

  Several imaging tests can be used to diagnose PAD: […] Doppler ultrasound is a special ultrasound technique that can help detect areas of restricted blood flow through an artery. […] Catheter angiography: This minimally invasive imaging exam relies on a contrast agent and x-rays to show blood flow in the arteries in the legs and to pinpoint any blockages that may be present. […] CT angiography (CTA): CT angiography uses a CT scanner to produce detailed views of the arteries in your abdomen, pelvis and legs. […] MR angiography (MRA): MR angiography is a noninvasive test that gives information similar to that of a CT without the ionizing radiation.

• #19 Peripheral artery disease: current diagnosis and management – The British Journal of Cardiology

  https://bjcardio.co.uk/2020/03/peripheral-artery-disease-current-diagnosis-and-management/

  Multiple imaging modalities have established effectiveness in diagnosing PAD and assessing appropriateness for revascularisation. […] Currently accepted modalities, which include duplex ultrasound (DUS), computed tomography angiography (CTA), and MRA, are all able to identify, localise, and assess the severity of vascular lesions. […] Based on these considerations, the ESC and the NICE guidelines recommend DUS as the first-line imaging technique in patients being considered for revascularisation, and MRA in those who require further imaging. […] The importance of identifying and treating concomitant risk factors cannot be overstated. […] Once the diagnosis of PAD has been established, a comprehensive treatment strategy that focuses on risk factor modification and improving prognosis should be promptly instituted.

• #20 PAD (Peripheral Artery Disease) – – Diagnosis, Evaluation and Treatment

  https://www.radiologyinfo.org/en/info/pad

  Several imaging tests can be used to diagnose PAD: […] Doppler ultrasound is a special ultrasound technique that can help detect areas of restricted blood flow through an artery. […] Catheter angiography: This minimally invasive imaging exam relies on a contrast agent and x-rays to show blood flow in the arteries in the legs and to pinpoint any blockages that may be present. […] CT angiography (CTA): CT angiography uses a CT scanner to produce detailed views of the arteries in your abdomen, pelvis and legs. […] MR angiography (MRA): MR angiography is a noninvasive test that gives information similar to that of a CT without the ionizing radiation.

• #21 PAD (Peripheral Artery Disease) – – Diagnosis, Evaluation and Treatment

  https://www.radiologyinfo.org/en/info/pad

  Several imaging tests can be used to diagnose PAD: […] Doppler ultrasound is a special ultrasound technique that can help detect areas of restricted blood flow through an artery. […] Catheter angiography: This minimally invasive imaging exam relies on a contrast agent and x-rays to show blood flow in the arteries in the legs and to pinpoint any blockages that may be present. […] CT angiography (CTA): CT angiography uses a CT scanner to produce detailed views of the arteries in your abdomen, pelvis and legs. […] MR angiography (MRA): MR angiography is a noninvasive test that gives information similar to that of a CT without the ionizing radiation.

• #22 Peripheral Arterial Occlusive Disease: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/460178-overview

  The following radiologic studies may be used to evaluate suspected PAOD: Angiography – The criterion standard for arterial imaging in the diagnosis of PAOD; usually reserved for when an intervention (either endovascular or traditional open surgery) is planned. […] For patients in whom medical and exercise therapy fail or those who have claudication symptoms that are lifestyle-limiting, surgical treatment includes either open bypass surgery or endovascular therapy (eg, stents, balloons, or atherectomy devices).

• #23 Patient education: Peripheral artery disease and claudication (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/peripheral-artery-disease-and-claudication-beyond-the-basics/print

  Claudication is the development of pain deep in the muscles of the leg (calves, thighs, or buttocks) during activity; the pain is relieved by resting the legs. […] The diagnosis of claudication is based upon the signs and symptoms described above. Doctors can do noninvasive tests to confirm the diagnosis and estimate the severity of the disease. […] The ankle-brachial index (ABI), also called the ankle-arm index, is used to confirm the diagnosis of PAD. The ABI measures the resting blood pressure at the ankle compared with the blood pressure in the arm. […] Blood pressure can be measured at other levels in the legs (calf, low thigh, high thigh) to determine the level and extent of PAD. […] Ultrasonography (ultrasound) is a noninvasive test that can be used to measure the blood flow and allow doctors to see the location and severity of the narrowing of the arteries.

• #24 Claudication | Inova

  https://www.inova.org/our-services/inova-schar-heart-and-vascular/conditions-treatments/claudication

  Claudication is a symptom of peripheral artery disease (PAD). Claudication occurs when the arteries in your legs do not receive enough blood and oxygen due to narrowed or blocked arteries. […] Your vascular specialist will try to determine if you have claudication and peripheral artery disease and then recommend the best treatment for you. Your evaluation will include questions about your symptoms, their location and how often and for how long they have occurred. […] Your physician may request other tests in order to make a diagnosis. These may include: Ankle brachial index (ABI), Pulse volume recording, which measures the volume of blood at various points in your legs, Duplex ultrasound, Blood tests for cholesterol, high blood sugar or other markers for artery disease, Magnetic resonance angiography (MRA), Computerized tomographic angiography (CTA), Angiography. […] A consultation with a vascular specialist is recommended to discuss the severity of the disease and the various treatment options available. Based on the result of your physical exam and your diagnostic testing, your vascular surgeon will treat your claudication.

• #25 Claudication: A Teachable Moment or Missed Opportunity!

  http://clinmedjournals.org/articles/cmrcr/clinical-medical-reviews-and-case-reports-cmrcr-4-186.php?jid=cmrcr

  Claudication is a common manifestation of Peripheral Arterial Disease (PAD) and atherosclerosis. Patients with claudication are at increased risk of cardiovascular events and limb-related complications. Optimal medical therapy is effective in relieving patient’s symptoms and reducing their risk of cardiovascular events. […] Medical management of patients with claudication is extremely effective and should be provided to all patients with claudication, even those who undergo revascularization to reduce their risk of cardiovascular events, improve their claudication symptoms and general health. […] Diagnosis is usually made after taking detailed history, doing physical examination and noninvasive studies. […] The most important diagnosis to consider is neurogenic claudication. […] Noninvasive indirect physiological tests include Ankle-Brachial Index (ABI), Toe Brachial Index (TBI), Segmental pressure measurement, Segmental Pulse Volume Recordings (PVR), and Digital Photoplethysmography (PPG).

• #26 Claudication – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/claudication/diagnosis-treatment/drc-20370959

  Claudication may go undiagnosed because many people consider the pain to be an unwelcome but typical part of aging. Some people simply reduce their activity level to avoid the pain. […] A diagnosis of claudication and peripheral artery disease is based on a review of symptoms, a physical exam, evaluation of the skin on the limbs, and tests to check blood flow. […] Some common tests used to diagnose claudication may include: […] Ankle-brachial index, a comparison of blood pressure in the ankles with the blood pressure in the arms […] Exercise testing to determine the maximum distance you can walk or the maximum exertion without pain. […] When peripheral artery disease is severe and other treatments don’t work, surgery may be required. Options include: […] Your health care provider may prescribe one or more medications to control pain and manage risk factors for cardiovascular disease.

• #27 Diagnosis and Treatment of Peripheral Arterial Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0901/p306.html

  Peripheral arterial disease (PAD) is atherosclerosis leading to narrowing of the major arteries distal to the aortic arch. The most common presenting symptom is claudication; however, only 10% of patients have classic claudication. The ankle-brachial index (ABI) can be used to screen for and diagnose PAD in the primary care setting. […] The clinical history and physical examination findings may suggest a diagnosis of PAD, especially in patients with multiple risk factors or classic claudication. Claudication must be distinguished from spinal stenosis (i.e., pseudoclaudication), peripheral neuropathies, musculoskeletal disorders and injuries, and deep venous thrombosis. […] The ankle-brachial index (ABI), the ratio of the ankle blood pressure to the highest brachial systolic pressure, is an inexpensive and efficient method to diagnose PAD in the primary care setting. It is highly sensitive (90%) and specific (98%). […] Diagnostic parameters for PAD at specific ABI values are listed in Table 2. […] Surgical revascularization should be considered in patients with lifestyle-limiting claudication symptoms that do not respond to exercise and pharmacologic treatment.

• #28 Neurogenic Claudication Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/neurogenic-claudication

  Neurogenic claudication results from compression of the spinal nerves in the lumbar (lower) spine. It is sometimes known as pseudoclaudication. […] A full physical exam and detailed interview will help a physician determine the type of pain and its origin. Certain symptoms can help a physician distinguish neurogenic claudication from vascular claudication for example, the pain of vascular claudication is often relieved simply by rest, while pain due to neurogenic claudication is best relieved by bending forward or sitting down. […] Various imaging studies can confirm a diagnosis of neurogenic claudication and help determine if the cause is spinal stenosis. These studies include: […] Neurogenic claudication is usually caused by spinal stenosis (narrowing of the spinal canal) in the lumbar spine (lower back). The narrowing of the spinal canal is generally caused by wear and tear and arthritic changes in the lower spine. […] In general, the goal of surgical treatment is to decompress (remove the pressure from) the nerve roots in the lumbar spine.

• #29 Peripheral Arterial Occlusive Disease Differential Diagnoses

  https://emedicine.medscape.com/article/460178-differential

  Various disease processes mimic claudication symptoms and must be excluded before a diagnosis of peripheral arterial occlusive disease (PAOD) can be made. […] Diabetic neuropathy – The pain is due to a peripheral neuritis; differentiation from intermittent claudication can be difficult because of accompanying skin discoloration and diminished pulses; extensive neurologic evaluation is essential. […] Venous thrombosis – Swelling and leg pain occur with walking; pain is relieved by extremity elevation, a finding that distinguishes this entity from arterial insufficiency.

• #30 Peripheral Arterial Occlusive Disease Differential Diagnoses

  https://emedicine.medscape.com/article/460178-differential

  Various disease processes mimic claudication symptoms and must be excluded before a diagnosis of peripheral arterial occlusive disease (PAOD) can be made. […] Diabetic neuropathy – The pain is due to a peripheral neuritis; differentiation from intermittent claudication can be difficult because of accompanying skin discoloration and diminished pulses; extensive neurologic evaluation is essential. […] Venous thrombosis – Swelling and leg pain occur with walking; pain is relieved by extremity elevation, a finding that distinguishes this entity from arterial insufficiency.

• #31 Intermittent Claudication – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430778/

  The guiding principle of treatment for intermittent claudication is that around 1% to 2% of patients with claudication ever progress to limb-threatening ischemia. Under this pretense, initial aggressive treatment strategies are discouraged. Most patients with intermittent claudication can be treated with medical interventions. […] Any patient with intermittent claudication or peripheral arterial disease should also be evaluated for coexisting cardiac disease. If symptoms are worsening despite medical treatment, or if symptoms are considered disabling or lifestyle-limiting, intervention may be considered. […] The differential diagnosis of intermittent claudication include: Sciatica, Atheroembolic disease, Venous insufficiency, Vasculitis. […] The prognosis of intermittent claudication depends on many factors. For those who continue to smoke, have uncontrolled hypertension or elevated blood glucose, the condition can progress, leading to ischemia, necrosis, and eventually culminate in the amputation of the limb.

• #32 Intermittent Claudication – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430778/

  The guiding principle of treatment for intermittent claudication is that around 1% to 2% of patients with claudication ever progress to limb-threatening ischemia. Under this pretense, initial aggressive treatment strategies are discouraged. Most patients with intermittent claudication can be treated with medical interventions. […] Any patient with intermittent claudication or peripheral arterial disease should also be evaluated for coexisting cardiac disease. If symptoms are worsening despite medical treatment, or if symptoms are considered disabling or lifestyle-limiting, intervention may be considered. […] The differential diagnosis of intermittent claudication include: Sciatica, Atheroembolic disease, Venous insufficiency, Vasculitis. […] The prognosis of intermittent claudication depends on many factors. For those who continue to smoke, have uncontrolled hypertension or elevated blood glucose, the condition can progress, leading to ischemia, necrosis, and eventually culminate in the amputation of the limb.

• #33 Intermittent Claudication – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430778/

  The guiding principle of treatment for intermittent claudication is that around 1% to 2% of patients with claudication ever progress to limb-threatening ischemia. Under this pretense, initial aggressive treatment strategies are discouraged. Most patients with intermittent claudication can be treated with medical interventions. […] Any patient with intermittent claudication or peripheral arterial disease should also be evaluated for coexisting cardiac disease. If symptoms are worsening despite medical treatment, or if symptoms are considered disabling or lifestyle-limiting, intervention may be considered. […] The differential diagnosis of intermittent claudication include: Sciatica, Atheroembolic disease, Venous insufficiency, Vasculitis. […] The prognosis of intermittent claudication depends on many factors. For those who continue to smoke, have uncontrolled hypertension or elevated blood glucose, the condition can progress, leading to ischemia, necrosis, and eventually culminate in the amputation of the limb.

• #34 Claudication: Symptoms, causes, and treatments

  https://www.medicalnewstoday.com/articles/326553

  A doctor may diagnose claudication when identifying and treating an underlying cause. […] To diagnose claudication and the condition causing it, a doctor will often: check several pulse points in the legs and feet, review the persons medical history, ask questions about symptoms, perform a physical exam, order a base lipid profile to find levels of circulating fats, use a Doppler ultrasound to look at blood flow in the impacted area, use the ankle-brachial index (ABI) to compare the ratio of blood pressure in the ankle to the arm. Claudication is common with ABI scores between 0.4 and 0.9 […] A doctor may also determine the severity of claudication to monitor how it progresses. By some classification systems, claudication severity is: mild with symptoms after walking 900 feet, moderate with symptoms after walking 600 feet, severe with symptoms after walking 300 feet.

• #35

  https://empendium.com/mcmtextbook/table/031_0377

  Claudication (hip, thigh, buttock) […] Painful discomfort, weakness […] Always after the same defined type/amount of exercise […] Resolves rapidly […] Pain can be induced in repeated manner […] Claudication (lower leg/calf) […] Cramp […] Always after the same defined type/amount of exercise […] Resolves rapidly […] Pain can be induced in repeated manner […] Claudication (foot) […] Severe deep pain, numbness […] Always after the same defined type/amount of exercise […] Resolves rapidly […] Pain can be induced in repeated manner.

• #36 Diagnosis And Treatment Options For Claudication – Klarity Health Library

  https://my.klarity.health/diagnosis-and-treatment-options-for-claudication/

  Early diagnosis of arterial narrowings is essential in order to build a treatment plan tailored for the individual, and also to prevent further development of the arterial disease. […] Diagnosis can involve a physical examination, along with the use of diagnostic tests, such as ABPI, treadmill exercise testing, duplex ultrasound and angiography.

• #37 Claudication: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21972-claudication

  Claudication is muscle pain that happens when you’re active and stops when you rest. […] Early diagnosis and treatment lead to better outcomes. […] Vascular claudication is usually a symptom of serious blood flow problems, especially peripheral artery disease (PAD). […] To find out if you have claudication or how severe your case is your healthcare provider will perform a physical exam. […] A provider may order these tests to diagnose claudication: Ankle-brachial index, Angiography, Ultrasound. […] Treating claudication is important because it usually means you have peripheral artery disease or another circulatory disease that can be life-changing and even deadly. […] If medicines don’t work, your provider may want to do a minimally invasive treatment. […] Claudication won’t go away by itself. You’ll need some level of treatment to manage it. […] Early diagnosis and treatment can prevent or delay the worsening of claudication symptoms to the point where they impact your life.

• #38 Intermittent claudication

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1635612/

  Patients with intermittent claudication have a significantly higher mortality than age matched controls, about 12% a year. […] The natural course of intermittent claudication is benign for the leg affected, with few patients ever requiring intervention or amputation. Only one in four patients with intermittent claudication will develop any deterioration in symptoms. […] Recognise the symptoms of intermittent claudication early […] Ideally, confirm the diagnosis by measuring ankle-brachial pressure indices in the community […] There is clear evidence that antiplatelet drugs reduce major cardiovascular events. They also reduce the risk of arterial occlusion and the requirement for revascularisation procedures. […] There is some evidence that statins improve the symptoms of claudication, increasing walking distance and pain-free walking time.

• #39 Claudication: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21972-claudication

  Claudication is muscle pain that happens when you’re active and stops when you rest. […] Early diagnosis and treatment lead to better outcomes. […] Vascular claudication is usually a symptom of serious blood flow problems, especially peripheral artery disease (PAD). […] To find out if you have claudication or how severe your case is your healthcare provider will perform a physical exam. […] A provider may order these tests to diagnose claudication: Ankle-brachial index, Angiography, Ultrasound. […] Treating claudication is important because it usually means you have peripheral artery disease or another circulatory disease that can be life-changing and even deadly. […] If medicines don’t work, your provider may want to do a minimally invasive treatment. […] Claudication won’t go away by itself. You’ll need some level of treatment to manage it. […] Early diagnosis and treatment can prevent or delay the worsening of claudication symptoms to the point where they impact your life.

• #40 Intermittent claudication

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1635612/

  Patients with intermittent claudication have a significantly higher mortality than age matched controls, about 12% a year. […] The natural course of intermittent claudication is benign for the leg affected, with few patients ever requiring intervention or amputation. Only one in four patients with intermittent claudication will develop any deterioration in symptoms. […] Recognise the symptoms of intermittent claudication early […] Ideally, confirm the diagnosis by measuring ankle-brachial pressure indices in the community […] There is clear evidence that antiplatelet drugs reduce major cardiovascular events. They also reduce the risk of arterial occlusion and the requirement for revascularisation procedures. […] There is some evidence that statins improve the symptoms of claudication, increasing walking distance and pain-free walking time.

• #41 Peripheral artery disease: current diagnosis and management – The British Journal of Cardiology

  https://bjcardio.co.uk/2020/03/peripheral-artery-disease-current-diagnosis-and-management/

  After establishing a patients risk factors for PAD, a thorough vascular examination is essential. […] Following a comprehensive history and physical examination, patients suspected of having undiagnosed atherosclerotic PAD should undergo further non-invasive, confirmatory testing. […] The initial test of choice for diagnosing lower extremity PAD is the ankle-brachial index (ABI). […] An ABI between 1.00 and 1.40 is considered in the normal range, and a value 0.90 is considered diagnostic of PAD. […] Importantly, while the guidelines from the European Society of Cardiology (ESC) and the National Institute for Health and Care Excellence (NICE) both recommend ABI as the initial diagnostic investigation in individuals with suspected PAD, this should not be construed as a screening recommendation for all individuals.

• #42 Peripheral artery disease: current diagnosis and management – The British Journal of Cardiology

  https://bjcardio.co.uk/2020/03/peripheral-artery-disease-current-diagnosis-and-management/

  Multiple imaging modalities have established effectiveness in diagnosing PAD and assessing appropriateness for revascularisation. […] Currently accepted modalities, which include duplex ultrasound (DUS), computed tomography angiography (CTA), and MRA, are all able to identify, localise, and assess the severity of vascular lesions. […] Based on these considerations, the ESC and the NICE guidelines recommend DUS as the first-line imaging technique in patients being considered for revascularisation, and MRA in those who require further imaging. […] The importance of identifying and treating concomitant risk factors cannot be overstated. […] Once the diagnosis of PAD has been established, a comprehensive treatment strategy that focuses on risk factor modification and improving prognosis should be promptly instituted.

• #43 Intermittent Claudication | Ohio State Medical Center

  https://wexnermedical.osu.edu/heart-vascular/vascular-care/claudication

  Claudication can indicate you have underlying systemic atherosclerosis and a significantly increased risk for heart attack and stroke. […] Because of this, your symptoms of claudication should be assessed. […] If you are diagnosed with claudication, you should be screened for coronary and carotid artery disease. […] Tests to check for claudication include: Ankle-brachial index (ABI) A test that measures blood pressure in the effected extremity, Ultrasound A test that uses high-frequency sound waves to evaluate blood flow in a vessel, Angiogram An X-ray of blood vessels to identify blockage; it is performed by inserting a tube into an arte.

• #44 Peripheral arterial disease Diagnosis and management in general practice

  https://www.racgp.org.au/afp/2013/june/peripheral-arterial-disease-diagnosis

  Careful history, clinical examination, and measurement of ankle-brachial index remain the initial means of diagnosing PAD. […] Ankle-brachial index measurement should be the initial diagnostic tool used in general practice, although nurse-determined oscillometric ABI has been shown to lack sensitivity. […] For atypical exertional leg pain, post-exercise ABI should be measured. […] More detailed anatomical information about PAD may be required to exclude abdominal aortic aneurysm (which can occur in up to 10% of patients with PAD), or popliteal aneurysm, which might be suggested by prominent popliteal pulses, and to plan endovascular or open surgical intervention. […] While catheter DSA remains the gold standard for imaging peripheral arteries, it is rarely used for diagnosis because of its invasive nature and the availability of non-invasive imaging modalities (ie. DUS, CTA, MRA). […] Patients should be referred to a vascular surgeon when the diagnosis is uncertain. […] Patients with lifestyle limiting symptoms that do not improve with medical management should also be considered for intervention.

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