Intermittent claudication: initial assessment and management.

An illustrative case history shows the presenting symptoms of intermittent claudication, revealing how clinical impression can lead the physician to suspect either a minor manifestation of progressive disease which will not affect the patient's health for some time to come, if he modifies his risk factors, or an early manifestation of a painful, progressive and fatal disease. Resolution of pain involves adaptation of recreational activity, reduction of smoking, and weight control. It must be established whether the claudication is persistent, or if intermittent, whether it interferes with the patient's daily functioning. A regular walking program will encourage collateral circulation. Bypass surgery should be considered if other methods fail to control the pain; percutaneous transluminal angioplasty is also a possibility.