TAILIEUCHUNG - Intermittent Claudication

A 58-year-old, previously healthy mail carrier reports cramping pain in his right calf when he walks. The discomfort has progressively worsened over the past 6 months and now forces him to rest after walking half a block on level ground at a normal pace. The pain is interfering with his ability to perform his job. He has a normal right femoral pulse and a diminished right popliteal pulse; the right ankle and foot pulses are absent. How should this patient be evaluated and treated? Should he undergo revascularization?. | Intermittent Claudication Intermittent Claudication Christopher White . This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented followed by a review offormalguidelines when they exist. The article ends with the author s clinical recommendations. A 58-year-old previously healthy mail carrier reports cramping pain in his right calf when he walks. The discomfort has progressively worsened over the past 6 months and now forces him to rest after walking halfa block on level ground at a normal pace. The pain is interfering with his ability to perform his job. He has a normal right femoral pulse and a diminished right popliteal pulse the right ankle and foot pulses are absent. How should this patient be evaluated and treated Should he undergo revascularization the clinical problem Peripheral arterial disease is a common manifestation of atherosclerosis and its prevalence increases with age and the presence of cardiovascular risk 2 Cigarette smoking and diabetes mellitus are the strongest risk factors more than 80 of patients with peripheral arterial disease are current or former smokers. Hypertension dyslipidemia and hyperhomocysteinemia also significantly increase the risk of peripheral arterial disease. Most persons with this disease are asymptomatic and the condition is detected during routine physical examination of abnormal pulses vascular bruits or an abnormal value for the ankle-brachial 4 Less than 20 of patients with peripheral arterial disease report the typical symptom of intermittent claudication leg-muscle discomfort on exertion that is relieved with Many patients present with atypical symptoms including leg fatigue difficulty walking and leg pain that is not typical of claudication. Studies of the natural history of intermittent claudication indicate that the risk of limb loss for patients who do not have diabetes is low 2 or less .6 However

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