Intermittent claudication occurred in 16 (22 legs) despite the presence of a pedal pulse at rest. Exercise, by walking or toe-stands, sufficient to induce claudication resulted in disappearance of the pedal pulse until the claudication subsided (one to three minutes) when the pulse was again palpable. Blood pressure at the ankle normally declines with exercise due to dilatation of the muscular vascular bed. Proximal occlusive disease results in a profound fall in distal blood pressure with concomitant loss of the pedal pulse. There was atherosclerotic occlusive disease at the aorto-iliac level in nine legs and at the femoro-popliteal level in nine legs. Traumatic or congenital arterial disease occurred in four legs. There were persistent pedal pulses after arterial reconstruction in 19 legs, and three have not been treated. Claudication in the presence of resting pedal pulses is usually associated with major artery disease that is amenable to reconstruction.
Intermittent claudication is pain affecting the calf, and less commonly thigh and buttock, that is induced by exercise and relieved by rest. Symptom severity varies from mild to severe. Intermittent claudication occurs as a result of muscle ischaemia during exercise caused by obstruction to arterial flow. It is a common problem, with a prevalence of 0.6-10%1 which increases significantly with age. Almost a fifth of the population over the age of 65 has intermittent claudication,2 and, as a result of demographic changes in many developed countries, its prevalence in the general population is likely to rise dramatically over the next 20 years.
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