Services
- Email Advice: VascularAdvice@nhslothian.scot.nhs.uk
- RIE: Refer to Vascular Surgeons only.
Claudication can be managed in primary care for most patients.97-99% of patients who claudicate will NOT progress to critical limb ischaemia over 5yr
Typical Features of Intermittent Claudication:
- Pain in lower limb muscle groups with walking (calf, buttock, thigh). Relieved within minutes by rest
- Pain often described as “cramping” or “gripping”
- Patients often have other manifestations of atherosclerosis (coronary heart disease, cerebrovascular disease etc)
- Patients will usually have risk factors for atherosclerosis (smoking, diabetes mellitus, hypertension, hypercholesterolaemia)
- Patients will usually have absent or reduced pulses and a reduced ankle-brachial pressure index (ABPI). ABPI measurement is not required in the presence of a convincing history and clinic examination.
R.C & A.T 05-04-23
At this time, we are unable to accept referrals for patients with claudication who have not commenced smoking cessation and have not had a 6-month trial of best medical therapy. 97-99% of claudicants will NOT progress to critical limb ischaemia over 5 years.
It must be highlighted that intervention for claudication has poor outcomes in patients who continue to smoke.
Who to refer:
- Patients with critical limb ischaemia – Non-healing arterial ulceration, gangrene or two weeks or more of rest pain– please refer URGENTLY.
- Patients with very sudden onset claudication, or those who may have a non-atherosclerotic cause for their symptoms.
- Patients with debilitating or livelihood limiting claudication, who are on a smoking cessation therapy and have had a 6 month trial of best medical therapy:
- Smoking cessation
- Antiplatelet agent (Aspirin or Clopidogrel)
- Statin therapy
- Exclude/ manage hypertension
- Exclude/ manage diabetes
- Patients should be encouraged to walk for 30 minutes, 3-5 times per week. They can stop as often as they need to. They do not need to try to ‘walk through’ the pain.
Fit for Health (Supervised Exercise Programme)
Vascular Surgery have created a Patient Information Leaflet Vascular Surgery-Intermittent Claudication V1.0.pdf
Who not to refer:
- Patients with intermittent claudication who are active smokers and won’t engage with smoking cessation services, haven’t had 6m trial of best medical therapy and regular exercise.
- Patients with a clear diagnosis of intermittent claudication, secondary to atherosclerosis, which is not lifestyle limiting.
How to refer:
- SCI Gateway (Basic SIGN Referral)
- VascularAdvice For advice only, if you are uncertain about referral email This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Information to include in referral:
- Description of symptoms and time course
- Effect the claudication is having on their life
- Presence or absence of risk factors, and how these have been addressed
- Other manifestations of atherosclerosis and co-morbidities
- Response to best medical therapy
- Presence or absence of pulses in symptomatic and contralateral leg
Peripheral arterial disease: diagnosis and management. NICE Clinical guideline [CG147].https://www.nice.org.uk/guidance/CG147
Peripheral Artery Disease BMJ, February, 2018. doi: https://doi.org/10.1136/bmj.j5842
