Angina of the Legs

What is Angina?

Angina is a well-known medical term most commonly used to define one of the most prominent symptoms of coronary artery disease: chest pain. Angina (or angina pectoris) causes an individual to experience chest pain due to a lack of oxygenated blood flow to the heart’s muscles. 

Reduced blood flow to the heart occurs when our coronary arteries become narrower due to a build-up of plaque within them, restricting the amount of blood flow through them. While angina appears to be relatively well known, the same cannot be said for claudication, a very similar condition that occurs in the leg muscles.

What is Leg Angina (Peripheral Vascular Disease, Claudication)?

Like angina pectoris, claudication is considered more of a symptom of a disease rather than a condition itself. Claudication is the pain that individuals experience as a result of having peripheral vascular disease (also referred to as peripheral artery disease and arteriosclerosis obliterans). This is a condition in which the arteries responsible for supplying the lower body with oxygenated blood become narrowed or blocked as a result of plaque build up. Those who suffer from claudication most commonly experience pain in their thigh, buttocks, or calf muscles while walking or performing some form of physical activity.  

Signs and Symptoms

The severity and range of symptoms can vary from person to person, however most individuals suffering from claudication will suffer mild symptoms, with some suffering none at all. Below are some of the most common symptoms:

• Leg pain while walking or performing physical activity
• Leg pain that subsides with rest
• One or both of the legs feeling numb
• Leg/feet pain while in bed at night
• Developing sores that take long to heal or don’t appear to heal
•  Blotchy skin
• Leg appearing pale when raised
• Legs feeling cold

Causes and Risk Factors

The primary cause of claudication is the narrowing of the arteries that supply the lower body with oxygenated blood flow. When arteries such as the peroneal, iliac, or femoral become narrowed due to a build-up of plaque, blood flow to certain areas of the leg becomes restricted. Consequently, the body is unable to pump sufficient amounts of oxygen and nutrients to the working muscles during exercise, causing them to become damaged and experience pain. Research has identified the factors listed below as the primary risk factors in the development of claudication:¹

• Being over the age of 65
• Being male
• Smoking
• Physical inactivity
• Poor diet
• Family history of peripheral vascular disease
• Obesity
• Diabetes

Diagnosis

For most individuals, a doctor will make an initial assessment of your condition by reviewing your symptoms. Your doctor will likely physically examine your visible conditions as well as ask you questions about other symptoms. After an initial assessment, your doctor may perform some of the following tests:

Ankle-brachial pressure index

ABPI is a simple test that utilises sound waves to measure if the blood pressure in your upper body matches the blood pressure in the lower body. The test is completely painless and is performed whilst you are laid down and relaxed. 

Angiogram

Commonly only used if the ABPI test result provides inconclusive evidence. An angiogram involves a dye being injected into the bloodstream before a CT scan is used to take a clear image of your arteries, allowing medical professionals to identify where any potential blockages may have occurred

Ultrasound scan

Again typically only used if ABPI is inconclusive. An ultrasound involves sound waves being passed through the body, creating an image of your arteries. Like an angiogram, this allows medical professionals to identify the locations where blockages may have occurred.

Prevention

Like many medical conditions, research has found the most effective way to reduce your risk of developing claudication is by leading a healthy lifestyle. ² Below are some of the healthy lifestyle choices most effective at helping reduce the risk of developing claudication:

• Performing at least 150 minutes of moderate to intense aerobic exercise per week (walking, jogging, cycling, etc.)
• Eating a healthy and balanced diet low in saturated fats and sugary products
• Eating 5 portions of fruit and veg each day
• Maintaining a healthy weight
• Maintaining healthy blood pressure, blood sugar, and cholesterol levels
• Avoiding smoking/drug use

Management and Treatment

Like angina pectoris, the type of treatment and management options available to those diagnosed with claudication depends greatly on their symptoms and the severity of their condition. Below are some of the methods most commonly used to treat and manage claudication.

Medication

Naftidrofuryl Oxalate: A form of medication that helps improve blood flow to certain areas of the body. This is typically prescribed to patients who suffer from pain during walking or physical activity.

Blood Thinning Medication: Medical professionals may prescribe you blood-thinning medication such as rivaroxaban, clopidogrel, or low-dose aspirin to help reduce your risk of blood clots.

Statins: Statins are prescribed to those with high cholesterol levels. Statins help lower and then control individuals' cholesterol levels.

Lifestyle Changes

Exercise: Clinical trials identified that regular physical activity could help improve the quality of life of those diagnosed with claudication, as well as reduce the severity of their symptoms and manage their condition.³

Healthier Diet: Cutting down on saturated fats, sugars, and salt can play a vital role in managing claudication and peripheral vascular disease, helping reduce blood pressure and the risk of further arterial plaque build-up.

Stop smoking: Continuing to smoke after being diagnosed has been shown to significantly increase claudication patients’ risk of suffering from a heart attack. Furthermore, studies have found that only 42% of those who continue to smoke after diagnosis survive more than ten years.⁴

Surgery

Artery bypass graft: A blood vessel is taken from another part of the body and used to redirect blood flow around the blocked or narrowed part of an artery, restoring blood flow to the legs.

Angioplasty: A small balloon is inserted into a blood vessel and directed to the blood vessel that has become blocked or narrowed. Once in position, the balloon is inflated, increasing the width of the artery, and allowing an increased supply of blood to flow through.

Complications

Whilst claudication is not considered an immediate threat to life, NICE reports that 20% of those with claudication will experience more severe complications later on in life, especially if their condition remains untreated or poorly managed.⁵ Below are some of the complications that can occur as a result of claudication.

Peripheral Vascular disease: As claudication is normally a symptom of peripheral vascular disease, those with the condition are naturally at an increased risk of being diagnosed with peripheral vascular disease.

Cardiovascular complications: As claudication is considered a sign of poor cardiovascular health, research has identified that those with the condition are at an increased risk of suffering from the following cardiovascular diseases and complications:⁶

• Myocardial infarction (heart attack)
• Congestive heart failure
• High blood pressure
• Coronary heart disease
• Pulmonary embolism

Critical limb ischaemia (CLI): In severe cases, critical limb ischaemia, a condition where blood vessels become critically blocked, can develop in those with claudication/peripheral vascular disease. CLI can cause a range of complications including loss of muscle strength and size.

When to See a Doctor

Those who regularly suffer from leg pain whilst walking or performing physical activity should contact their healthcare provider as soon as possible to book an appointment. Early treatment and management can help control your condition, preventing more severe complications from occurring while also allowing you to lead a pain-free and healthier lifestyle.

Summary

Claudication is not considered an immediate threat to life, but it is a condition that can get progressively worse and cause more severe complications if left untreated. If you suffer from any of the aforementioned symptoms, ensure to book an appointment with your healthcare provider to help treat your condition. For those already diagnosed with the condition, ensure to keep following the medication/lifestyle guidance given to you by your doctor, as this will allow you to continue to lead a normal life and prevent future complications.