{"id":4053,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/intermittentclaudication\/"},"modified":"2025-08-18T09:37:21","modified_gmt":"2025-08-18T08:37:21","slug":"intermittentclaudication","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/vascularsurgery\/intermittentclaudication\/","title":{"rendered":"Intermittent Claudication"},"content":{"rendered":"\n<ul class=\"wp-block-list\">\n<li>Claudication can be managed in primary care for most patients.97-99% of patients who claudicate will NOT progress to critical limb ischaemia over 5years. <\/li>\n\n\n\n<li>A patient information leaflet has been created which provides detailed information for patients in how to help manage their symptoms.&nbsp; <\/li>\n\n\n\n<li>Please provide this to patients <a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vascular-Surgery-Intermittent-Claudication-V1.0.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vascular-Surgery-Intermittent-Claudication-V1.0.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Patient Information Leaflet&nbsp;Vascular Surgery-Intermittent Claudication <\/a>V1.0.pdf<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Typical Features of Intermittent Claudication: <\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Pain in lower limb muscle groups with walking (calf, buttock, thigh). Relieved within minutes by rest<\/li>\n\n\n\n<li>Pain often described as &#8220;cramping&#8221; or &#8220;gripping&#8221;<\/li>\n\n\n\n<li>Patients often have other manifestations of atherosclerosis (coronary heart disease, cerebrovascular disease etc)<\/li>\n\n\n\n<li>Patients will usually have risk factors for atherosclerosis (smoking, diabetes mellitus, hypertension, hypercholesterolaemia)<\/li>\n\n\n\n<li>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.<\/li>\n<\/ul>\n\n\n\n<p>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. <\/p>\n\n\n\n<p>It must be highlighted that intervention for claudication has poor outcomes in patients who continue to smoke.<\/p>\n\n\n\n<p><strong>D.R.M &amp; A.T 25-10-24<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients with critical limb ischaemia \u2013 Non-healing arterial ulceration, gangrene or two weeks or more of rest pain\u2013&nbsp;<strong><em>please refer URGENTLY<\/em><\/strong>.<\/li>\n\n\n\n<li>Patients with very sudden onset claudication, or those who may have a non-atherosclerotic cause for their symptoms.<\/li>\n\n\n\n<li>Patients with&nbsp;debilitating or livelihood limiting claudication, who&nbsp;are on a smoking cessation&nbsp;therapy and have had a 6 month trial of best medical therapy:\n<ul class=\"wp-block-list\">\n<li>Smoking cessation<\/li>\n\n\n\n<li>Antiplatelet agent (Aspirin or Clopidogrel)<\/li>\n\n\n\n<li>Statin therapy<\/li>\n\n\n\n<li>Exclude\/ manage hypertension<\/li>\n\n\n\n<li>Exclude\/ manage diabetes<\/li>\n\n\n\n<li>Patients should be&nbsp;encouraged to&nbsp;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 &#8216;walk through&#8217; the pain.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p>Patients with intermittent claudication can be referred to Fit for Health.&nbsp; Fit for Health is a physical activity programme delivered by Edinburgh Leisure in partnership with Edinburgh Health and Social Care partnership.&nbsp; Patients must be registered with an Edinburgh GP Practice, aged 16+ and be safe, able and motivated to exercise.&nbsp; Classes are delivered within Edinburgh Leisure venues<\/p>\n\n\n\n<p>Vascular Surgery have created a <a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vascular-Surgery-Intermittent-Claudication-V1.0.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vascular-Surgery-Intermittent-Claudication-V1.0.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Patient Information Leaflet&nbsp;Vascular Surgery-Intermittent Claudication <\/a>V1.0.pdf this should be given to patients who have been referred and also to those that do not meet referral criteria.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients with intermittent claudication who are active smokers and won&#8217;t engage with smoking cessation services, haven&#8217;t had 6m trial of best medical therapy and regular exercise.<\/li>\n\n\n\n<li>Patients with a clear diagnosis of intermittent claudication, secondary to atherosclerosis, <strong>which is not lifestyle limiting.<\/strong><\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>SCI Gateway (RIE &gt; Vascular Surgery &gt;Basic SIGN Referral)<\/li>\n\n\n\n<li>If you are uncertain regarding referral or require advice, you can email Vascular Surgery for advice by clicking here   <a href=\"mailto:VascularAdvice@nhslothian.scot.nhs.uk\" target=\"_blank\" rel=\"noreferrer noopener\">VascularAdvice&nbsp;<\/a><\/li>\n<\/ul>\n\n\n\n<p><strong>Information to include in referral:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Description of symptoms and time course<\/li>\n\n\n\n<li>Effect the claudication is having on their life<\/li>\n\n\n\n<li>Presence or absence of risk factors, and how these have been addressed<\/li>\n\n\n\n<li>Other manifestations of atherosclerosis and co-morbidities<\/li>\n\n\n\n<li>Response to best medical therapy<\/li>\n\n\n\n<li>Presence or absence of pulses in symptomatic and contralateral leg<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vascular-Surgery-Intermittent-Claudication-V1.0.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vascular-Surgery-Intermittent-Claudication-V1.0.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Patient Information Leaflet&nbsp;Vascular Surgery-Intermittent Claudication <\/a>V1.0.pdf this should be given to patients who have been referred and also to those that do not meet referral criteria.<\/p>\n\n\n\n<p>Peripheral arterial disease: diagnosis and management. NICE Clinical guideline [CG147].<a rel=\"noreferrer noopener\" href=\"https:\/\/www.nice.org.uk\/guidance\/CG147\" target=\"_blank\">https:\/\/www.nice.org.uk\/guidance\/CG147<\/a><\/p>\n\n\n\n<p>Peripheral Artery Disease BMJ, February, 2018. doi:&nbsp;<a rel=\"noreferrer noopener\" href=\"https:\/\/doi.org\/10.1136\/bmj.j5842\" target=\"_blank\">https:\/\/doi.org\/10.1136\/bmj.j5842<\/a><\/p>\n\n\n\n<p>Video for patients explaining self-help\/conservative management for intermittent claudication <a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DF3wGuzFKSWk&amp;data=05%7C01%7Crebecca.cheesbrough%40nhslothian.scot.nhs.uk%7C93f3db20f1ae42fbaaac08db35006249%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638162047980751788%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&amp;sdata=vOmdJEsub%2BIPs9XiLc%2FpVb1DKLJyR5gX5q%2BkZ5hEy%2BQ%3D&amp;reserved=0\">https:\/\/www.youtube.com\/watch?v=F3wGuzFKSWk<\/a><\/p>\n\n\n\n<p><\/p>\n<\/div><\/div>\n<\/div>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Typical Features of Intermittent Claudication: 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. It must be highlighted that intervention for claudication has poor outcomes in patients who continue to smoke. D.R.M &amp; A.T<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4504,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[680],"class_list":["post-4053","page","type-page","status-publish","hentry","category-intermittentclaudication"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/vascularsurgery\/intermittentclaudication\/\" rel=\"tag\">Intermittent Claudication<\/a>","rttpg_excerpt":"Typical Features of Intermittent Claudication: 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. It must be highlighted that intervention for claudication has poor outcomes in patients who continue to smoke. D.R.M &amp; A.T","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4053","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4053"}],"version-history":[{"count":19,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4053\/revisions"}],"predecessor-version":[{"id":25179,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4053\/revisions\/25179"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4504"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4053"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4053"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}