Private peripheral arterial disease clinic in London, same-day cardiology.

Recognising claudication

• Cramping or aching in the calf, thigh or buttock on walking, at a fairly consistent distance
• Relieved within a few minutes of standing still — you do not need to sit down
• worse walking uphill, faster, or in cold weather
• cold feet, hair loss on the legs, slow-growing thickened toenails, and pale or shiny skin
• in men, erectile dysfunction can accompany aorto-iliac disease
• It is often mistaken for arthritis, sciatica or just getting older

This is a cardiovascular diagnosis

Having peripheral arterial disease means the same process is almost certainly present in the heart and neck arteries. Most people with claudication die of heart attack or stroke rather than losing a leg. That reframes the treatment: managing the cardiovascular risk is more important than treating the leg symptoms.

• Stop smoking. Nothing else comes close — it is the strongest risk factor and continuing smoking is the strongest predictor of progression and amputation.
• A statin for everyone with peripheral arterial disease, regardless of cholesterol level.
• Antiplatelet treatment, usually clopidogrel.
• Blood pressure and diabetes control.

Supervised exercise is first-line

Procedures

• Angioplasty and stenting for symptoms limiting quality of life despite exercise and medical treatment.
• Bypass surgery for extensive disease or where angioplasty is unsuitable.
• Urgent revascularisation for rest pain or tissue loss.
• Procedures relieve symptoms; they do not treat the underlying disease, so the medication and lifestyle measures continue regardless.

Foot care

Reduced blood supply means minor injuries heal poorly and can progress to ulcers. Check your feet daily, moisturise but not between the toes, wear well-fitting shoes, never walk barefoot, have toenails cut professionally if you cannot see or reach them, and seek help the same day for any break in the skin. This matters even more if you also have diabetes.