claudication

Claudication (from Latin claudicare, to limp) refers to ischemic muscle pain or cramping induced by exercise and relieved by rest. Intermittent claudication is the classic presentation of peripheral arterial disease (PAD) due to atherosclerotic narrowing of large and medium arteries, most commonly in the lower extremities. Pain typically occurs in the calf (femoral/popliteal artery disease), thigh (iliac disease), or buttock (aortoiliac disease). The location depends on which vessel is stenotic. Claudication distance is the distance a patient can walk before symptom onset; a short claudication distance (< 1 block) suggests more severe disease. Risk factors for PAD include smoking (strongest modifiable risk), diabetes, hypertension, dyslipidemia, and chronic kidney disease. Diagnosis includes ankle-brachial index (ABI, normal > 0.9), duplex ultrasound, CT angiography, or MR angiography. Critical limb ischemia (rest pain, tissue loss) is more severe than claudication and requires urgent revascularization. Management includes smoking cessation, exercise (walking program improves claudication distance), statins, antiplatelet therapy (aspirin or clopidogrel), and ACE inhibitors. Revascularization (angioplasty/stent or bypass) is considered for limiting claudication or critical limb ischemia. On boards, distinguish claudication (exercise-induced, resolves with rest) from neurogenic claudication (lumbar spinal stenosis, pseudo-claudication, pain with walking uphill, relief with sitting/spine flexion).