disabling claudication
Last edited 06/2018
Patients with disabling claudication have either:
- worsening claudication e.g. decreased exercise tolerance
- claudication that interferes with everyday life
The preferred treatment depends upon the severity of the disease and the overall fitness of the patient.
Options include:
- percutaneous balloon angioplasty
- local fibrinolytic therapy e.g. streptokinase 6000 units per hour, delivered directly through a catheter
- reconstructive arterial surgery
NICE suggests (2):
- first line therapy for intermittent claudication is supervised exercise programme
- angioplasty and stenting
- should be offered if intermittent claudication only when:
- advice on the benefits of modifying risk factors has been reinforced and
- a supervised exercise programme has not led to a satisfactory improvement in symptoms and
- imaging has confirmed that angioplasty is suitable for the person
- primary stent placement should not be offered for treating people with intermittent claudication caused by aorto-iliac disease (except complete occlusion) or femoro-popliteal disease
- should be offered if intermittent claudication only when:
- primary stent placement should be considered for treating people with intermittent claudication caused by complete aorto-iliac occlusion (rather than stenosis)
- bare metal stents should be used when stenting is used for treating people with intermittent claudication
- bypass surgery and graft types
- bypass surgery should be offered if severe lifestyle-limiting intermittent claudication only when:
- angioplasty has been unsuccessful or is unsuitable and
- imaging has confirmed that bypass surgery is appropriate for the person
- use an autologous vein whenever possible for people with intermittent claudication having infra-inguinal bypass surgery
- drug therapy if intermittent claudication:
- naftidrofuryl oxalate
- consider naftidrofuryl oxalate for treating people with intermittent
claudication only when:
- supervised exercise has not led to satisfactory improvement and
- the person prefers not to be referred for consideration of angioplasty or bypass surgery
- review progress after 3-6 months and discontinue naftidrofuryl oxalate if there has been no symptomatic benefit
- consider naftidrofuryl oxalate for treating people with intermittent
claudication only when:
- naftidrofuryl oxalate
Notes (1):
- endovascular
- percutaneous transluminal balloon angioplasty +/- stenting has been
shown to be effective in relieving the symptoms of patients with intermittent
claudication
- most common complication following the procedure is a groin haematoma. Bleeding from the groin requiring surgical correction occurs in less than 1% of procedures. Limb loss as a direct result of the intervention should occur in less than 1% of interventions for stable claudicants
- percutaneous transluminal balloon angioplasty +/- stenting has been
shown to be effective in relieving the symptoms of patients with intermittent
claudication
- surgery
- due to the potential risks of surgical intervention, operative treatment is mainly reserved for managing critical ischaemia and debilitating claudication that is unsuitable for endovascular treatments
Reference:
- 1. BHF Factfile (September 2009). Intermittent claudication and peripheral arterial disease
- 2. NICE (March 2018). Lower limb peripheral arterial disease: diagnosis and management