Current Management of Intermittent Claudication

Abstract

Peripheral artery disease (PAD) is a common condition representing a spectrum of clinical disease. Intermittent claudication, which is defined as PAD with lower extremity pain on exertion that resolves with rest, represents mild-to-moderate PAD. Intermittent claudication is associated with a low risk of limb loss long-term but is a significant marker of systemic cardiovascular risk. Here, we describe the workup, diagnosis, and management of intermittent claudication.

Keywords: Cardiovascular; Claudication; Intermittent claudication; Peripheral artery disease.

Fig. 1.

Example of a lower extremity noninvasive arterial Doppler evaluation demonstrating normal perfusion to the right lower extremity and mild arterial insufficiency to the left lower extremity in a patient with left lower extremity claudication.

Fig. 2.

Summary overview of treatment paradigm of patients with diagnosis of PAD and intermittent claudication. First-line management of intermittent claudication includes medical optimization of comorbid conditions and risk factors including hypertension, diabetes and dyslipidemia, as well as smoking cessation; and PAD-specific optimization including daily aspirin, statin, and initiation of SET. Second-line therapy involves the initiation of cilostazol in eligible patients. Third-line therapy for patients who are medically optimized and completed SET without benefit can be considered for potential revascularization.

Fig. 3.

The Society for Vascular Surgery SET App features is a physician-prescribed, 12-week home-based program. It also includes educational content, exercise scheduling and recording, a patient reported outcomes reporting system and coaching. It also includes a physician portal for them to follow their patient’s progress.