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by Kenneth Neldner, Lubbock,
TX
Texas Tech University Health Sciences Center
(from Volume 2, Issue 4, July 1994)
The
definition of intermittent claudication (IC) is discomfort
in the legs (and occasionally the arms) due to narrowed
arteries which then cause a deficient blood supply in
exercising muscles. The discomfort has been described as
pain, ache, cramping, or a tired, weak feeling brought on by
exercise or walking. It is felt most commonly in the calf
muscles, but it may occur in the foot, hip, or buttocks.
Symptoms are relieved within one to five minutes by rest,
following which time the individual can walk again, usually
as far as he or she could initially before again triggering
the discomfort causing more intermittent claudication.
Progression, or worsening of the process, is indicated when
the distance a person can walk without symptoms gradually
decreases. Intermittent claudication should never occur
when a person is at rest. Pains at rest are due to some
other cause.
There are several causes for narrowing of the peripheral
arteries. Ordinary (non-PXE) hardening of the arteries
(arteriosclerosis) and/or cholesterol deposition in the
vessels (atherosclerosis) are by far more common. PXE can
narrow the artery lumen by calcium deposition in the elastic
fibers present in the vessel wall.
This narrowing process progresses more slowly in PXE than in
other disorders; therefore, complete closure of an artery
almost never happens in PXE (there are rare exceptions).
Bypass surgical arterial grafting can be done but is seldom
necessary in PXE.
The best treatment is to avidly pursue a walk/rest program
(ideally 60 minutes per day) which will stimulate arteries
to develop new channels (collateral circulation) around the
narrowed sites. Those with PXE who are beyond about age 40
years and who do NOT have IC should be on a walking program
to help prevent its development.
Other treatments include Trental (pentoxifylline), 400 mg
three times daily, which helps to improve blood flow through
narrowed vessels. Beta blocker medications for hypertension
(such as Corgard, Inderal, Lopressor, Tenormin, and others)
may worsen IC in some individuals and should therefore be
avoided. There are other good antihypertensive medications
that can be taken, such as calcium antagonists (Procardia,
Cardizem, and others) which have helped IC in some
patients. Chelation therapy has not proven helpful, at
least in the long run.
Of all the medications available, Trental has seemed to be
most helpful and should be tried. But remember, it can
aggravate bleeding problems, so if anyone has had a recent
or threatened retinal hemorrhage or stomach bleeding, it
should not be taken (or should be stopped, if you are on
it). The same holds true for aspirin and the non-steroidal
anti-inflammatory drugs such as Motrin, Ibuprofen, Advil,
Naprosyn, and others which will also make bleeding worse.
Acetaminophen (Tylenol) has no effect on blood coagulation
and is therefore safe to take.
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