Intermittent claudication service

walk further for a healthier Life

The commonest presentation of peripheral arterial disease (PAD) is intermittent claudication (IC). This typically presents as pain on walking in the calf (sometimes the thigh or buttocks too) that is relieved by rest. Patients with IC are at an increased risk of coronary and cerebrovascular events. More than half of patients with PAD have significant co-existing coronary artery disease.

Treatment of this condition focuses on reducing the patients’ cardiovascular risk factors by:

Stopping smoking
Starting Best Medical Therapy (BMT). According to NICE guidelines, patients should be started on an antiplatelet (ideally Clopidogrel 75mg) and high dose (80mg) Atorvastatin.
Controlling hypertension
Controlling hyperglycaemia and weight management.

Establishing a regular exercise routine to improve walking distance complements this strategy and helps with the patients’ symptoms too.

Arterial intervention is rarely performed and is usually only indicated in patients with progressive disabling symptoms.

Intermittent claudication: About Us

Which patients should be referred to this service

Consider referring patients to this service if they have disabling calf, thigh or buttock pain on exercise that is relieved by rest.

Please complete the intermittent claudication proforma including the information below:

Ask about symptoms;

Which leg?
Pain on walking, relived by rest?
Location of pain?
Maximum walking distance?
Symptom history?
History of other vascular disease?

Examination:

Pulses present / absent
ABPI .

When should another service be used?

Chronic limb Threatening ischaemia (CLTI): patients presenting with ischaemic rest pain refer to the CLTI service.
Tissue loss: patients presenting with CTLI and tissue loss or severe infection refer urgently to on call vascular team.
Other cause of leg pain: (consider referral to spinal service or physiotherapy if no red flag symptoms present)
- pain immediately after standing
- pain not improved after resting (>10min),
- pain radiating to the hamstrings, shin and knee joints with no calf pain,
- concomitant back pain with atypical history of leg pain.

Who can make a referral?

Referrals can by made by GPs, district or practice nurses or any other suitably qualified health care professional.

Intermittent claudication service

Which patients should be referred to this service

When should another service be used?

Who can make a referral?

Further reading