PXE – Intermittent Claudication
by Dr Kenneth Neldner, Lubbock TX Texas Tech University Health Sciences Centre
The definition of intermittent claudication (IC) is discomfort in the legs (and occasionally the arms) due to narrowed arteries which then causes a deficient blood supply in exercising muscles. The discomfort has been described as pain, ache, cramping, or a tired, weak feeling brought on by exercise or walking. It is felt most commonly in the calf muscles, but it may occur in the foot, hip, or buttocks. Symptoms are relieved within one to five minutes by rest, following which time the individual can walk again, usually as far as he or she could initially before again triggering the discomfort causing more intermittent claudication. Progression, or worsening of the process, is indicated when the distance a person can walk without symptoms gradually decreases. Intermittent claudication should never occur when a person is at rest. Pains at rest are due to some other cause.
There are several causes for narrowing of the peripheral arteries. Ordinary (non-PXE) hardening of the arteries (arteriosclerosis) and/ or cholesterol deposition in the vessels (atherosclerosis) are by far more common. PXE can narrow the artery lumen by calcium deposition in the elastic fibres present in the vessel wall.
This narrowing process progresses more slowly in PXE than in other disorders; therefore, complete closure of an artery almost never happens in PXE (there are rare exceptions). By-pass surgical arterial grafting can be done but is seldom necessary in PXE.
The best treatment is to avidly pursue a walk/rest program (ideally 60 minutes per day) which will stimulate arteries to develop new channels (collateral circulation) around the narrowed sites. Those with PXE who are beyond about age 40 years and who do NOT have IC should be on a walking program to help prevent its development.
Other treatments include Trental (pentoxifylline), 400 mg three times daily, which helps to improve blood flow through narrowed vessels. Beta blocker medications for hypertension (such as Corgard, Inderal, Lopressor, Tenormin, and others) may worsen IC in some individuals and should therefore be avoided. There are other good antihypertensive medications that can be taken, such as calcium antogonists (Procardia, Cardizem, and others) which have helped IC in some patients. Chelation therapy has not proven helpful, at least in the long run.
Of all the medications available, Trental has seemed to be most helpful and should be tried. But remember, it can aggravate bleeding problems, so if anyone has had a recent or threatened retinal haemorrhage or stomach bleeding, it should not be taken (or should be stopped, if you are on it). The same holds true for aspirin and the non-steroidal anti-inflammatory drugs such as Motrin, Ibuprofen, Advil, Naprosyn, and others which will also make bleeding worse. Acetaminophen (Tylenol) has no effect on blood coagulation and is therefore safe to take.