Endovascular Treatment of Intermittent Claudication

What is intermittent claudication?

Intermittent claudication is a condition where blood flow to the leg is decreased during exertion. It is caused by a disease of the leg arteries that are narrowed or obstructed. As a result, leg pain or cramping occur during exertion such as walking, followed by the need to stop and rest. The pain appears in the calf muscles and may reach up to the buttock. After stopping the pain or cramps are relieved. Therefore, it is a limp that is intermittent. Tingling and decreased sensation of the leg may also occur.

What tests are performed to evaluate the condition?

Before complications arise, it is recommended to evaluate the presence of PAD (peripheral artery disease) by feeling leg pulses and comparing the blood pressure in the legs and arms. By using US (Doppler), blood flow velocities can be seen in the extremity arteries. If PAD is suspected, there may be additional need for arterial imaging by CTA or MRA to detect the obstructed arteries and to assist in the planning of treatment options.   

What is the endovascular treatment for intermittent claudication?

Endovascular treatment (catheterization) opens the obstructed blood vessels and improves blood flow to the leg. This minimally-invasive procedure, not involving surgery, is performed by an interventional radiologist using imaging-guided techniques.

The patient, lying down, is monitored for pulse, blood pressure and oxygen levels. The procedure is performed by an interventional radiologist after local anesthesia, usually in the groin area. Mild relaxation medication may also be administered. The doctor will then make a tiny incision and through it insert a thin tube (catheter) to the artery and maneuver it to the treatment site. A small amount of contrast agent is injected for the radiologist to properly view the arteries.

Thus, the arteries in the pelvis, thigh or calf are opened up with the assistance of small balloons or placement of stents (just like in cardiac catheterization). The obstruction or narrowing is opened and blood flow to the foot is therefore increased. There are no apparent sutures at the end of the procedure. The tiny incision on the skin is covered by a dressing. This procedure is usually completed within 2 hours.

What is recovery like after endovascular treatment?

After treatment the leg is not to be folded for several hours and the patient may not get out of bed for 6 hours. The patient is discharged the day after surgery, and may resume normal activity within several days.