From the Guidelines
Venous claudication, also known as intermittent claudication of the veins (ICV), is a condition characterized by bursting leg pain during exercise, likely caused by persistent venous obstruction of a major venous confluence. This condition is a form of secondary venous insufficiency, often presenting as a symptom of postthrombotic syndrome (PTS) 1. The symptoms of venous claudication differ from patient to patient and may be intermittent or persistent, usually worsening by the end of the day or with prolonged standing or walking, and improving with rest or limb elevation.
Some key characteristics of venous claudication include:
- Pain, swelling, heaviness, fatigue, itching, and cramping in the affected limb
- Symptoms worsen with prolonged standing or walking and improve with rest or limb elevation
- Pain can resemble arterial claudication but is relieved more slowly with rest
- Commonly results from deep vein thrombosis (DVT), chronic venous insufficiency, or external compression of veins
According to the American Heart Association 1, treatment of venous claudication focuses on addressing the underlying cause, which may include anticoagulation for DVT, compression therapy with graduated compression stockings, leg elevation, and in some cases, venous stenting or bypass procedures for severe obstruction. Regular walking exercise within pain limits can help develop collateral circulation, and weight management is also important as obesity can worsen symptoms by increasing pressure on veins.
From the Research
Definition and Overview of Venous Claudication
- Venous claudication, also known as intermittent claudication of the veins (ICV), is a condition characterized by leg pain, cramping, and fatigue brought on by exercise or ambulation, relieved by rest, but caused by inadequate venous blood flow rather than arterial insufficiency 2, 3, 4.
- It is often associated with deep venous abnormalities, such as iliofemoral obstruction, and is found almost exclusively in patients with this condition 2.
Pathophysiology
- The pathophysiology of venous claudication involves increased venous volume and pressure, leading to compartment edema and increased intramuscular pressure, resulting in tissue ischemia and hypoxia 2, 4.
- Exercise results in a marked venous volume overload, particularly in the thigh, which leads to pain 4.
- The time required for the venous pressure to return to pre-exercise levels in the affected limbs is prolonged compared to normal 2.
Clinical Importance and Diagnosis
- Venous claudication is an important symptom of venous outflow obstruction that is under-studied and merits further recognition 2.
- Diagnosis can be confirmed with duplex ultrasonography, and ascending and descending phlebography can demonstrate deep venous abnormalities associated with the condition 3.
- The prevalence of venous claudication has been reported to range from 10.6% to 74.0% in patients with iliofemoral obstruction 2.
Distinction from Arterial Claudication
- Venous claudication is distinct from intermittent claudication caused by peripheral arterial disease (PAD), which is characterized by leg muscle pain, cramping, and fatigue brought on by ambulation/exercise, relieved by rest, and caused by inadequate blood supply due to atherosclerosis 5.
- While PAD is a debilitating atherosclerotic disease of the lower limbs associated with an increased risk of cardiovascular morbidity and mortality, venous claudication is related to venous insufficiency and outflow obstruction 5, 2.