INTERMITTENT CLAUDICATION

¹ The University Department of Surgery, Manchester Royal Infirmary, Manchester, England

1. A description is given of historical discoveries relating to intermittent claudication. Various theories that have been advanced are discussed. A hypothesis, based on the work of Lewis, is elaborated.

2. A classification of obliterative arterial disease is outlined. The three groups that are distinguished are: primary thrombosis of the popliteal artery; juvenile obliterative arteritis; and senile obliterative arteritis.

3. The methods adopted for assessment of the severity of disease, including study of the clinical features, arteriographic findings, results of novocain infiltration and examination of the patient on a walking machine, are reported.

4. Methods of treatment by Buerger's exercises, contrast baths, intermittent venous occlusion and suction pressure; by lumbar ganglionectomy ant paravertebral block with phenol; by vitamin E (-tocopherol) therapy; by treatment with thiouracil antistin; by internal popliteal myoneurectomy and division of the external popliteal and posterior tibial nerves; and by tenotomy of the tendo Achillis, are discussed.

5. It is concluded that tenotomy of the tendo Achillis should replace myoneurectomy in Type 3 cases where the blood supply is so far reduced that vascular stability cannot be achieved, and that it might apply in Type 2 cases in which there is persistent pain at a steady level.

6. The results of treatment in 276 patients with intermittent claudication are recorded.