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Disabling claudication

Authoring team

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
    • 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

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
  • 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:


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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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